You Get What You Pay For

According to these data from IMS Health (above), the top ten selling biologics in the world account for more than a third of industry sales, while four of these enjoyed double-digit growth in 2010. Amgen and Pfizer market the top-selling biologic, Enbrel, which treats such inflammatory conditions as rheumatoid arthritis. A drug with similar uses, Humira from Abbott Laboratories, showed the most growth in 2010. Among the top ten selling biologics of 2010, only Lovenox—a Sanofi drug that prevents blood clots—experienced decreased growth. Overall, sales of the top ten biologics rose by an average of 8.3 percent.

Despite the growth in the sales of biologics around the world, many drugs are not available in certain countries. To explore the reason for this, we relied on data from Danzon and Furukawa (Danzon, P.M. & Furukawa, M.F. 2006. Prices and availability of biopharmaceuticals: An international comparison. Health Affairs 25:1353–1362). As shown in the graph of these data (right), the biologic sales per capita are the highest in the U.S., which also has the highest percentage of new global biologics available. Likewise, these figures indicate that the lowest biologic sales per capita come from Mexico, which also has the lowest percentage of new global biologics available. Looking across the plotted data as a whole, the general correlation—though not a perfect one—shows that lower biologic sales per capita lead to a lower percentage of new global biologics available.

Based on simple marketing, these data make perfect sense: A country with fewer biologics sales per capita presents a less appealing market for a company with a new drug. On the other hand, that same company will take its product to a country with a high rate of biologic sales per capita as soon as possible. In short, the manufacturer will go through the necessary regulatory hurdles to deliver a new biologic where it is likely to be sold. Without the likelihood of high sales, the expense of regulatory approval might leave the maker with a loss or too small a profit margin.

As the data suggest, if a country wants to increase its access to new biologics, it should encourage sales. This requires that governments work with providers as well as payers.