Epoetin tendering
The first recombinant human erythropoietin (epoetin alfa) was developed by Amgen and launched in Europe by J&J affiliates under the brand names Eprex® and Erypo® in 1989. This was followed shortly after with the launch of epoetin beta (Genetics Institute, Boehringer Mannheim) under the brand name Recormon®. Epoetinbeta was reformulated and re-launched as Neorecormon® by Roche in 1997.16
Epoetin alfa was the first biologic with large budget impact, global sales in 2000 were already over $3.5 billion.17 While there were differences between the brands (e.g. packaging18 and pain on injection19), there were no reports on differences in clinical efficacy.20 In most countries, epoetin is available as a hospital product and hence the situation was ideal for purchasers to introduce tendering as procurement method for the product.
Where possible, the subject for the tender was described as epoetin/erythropoietin/ ATC code B03XA01, creating a direct competitive tendering situation between the J&J and Roche brands. In other markets such as Italy, tendering was performed per brand and the outcome was used to guide therapeutic choice.
In the late 1990s, the epoetin procurement system of choice was tendering in almost all European countries (excluding Austria, Germany, Greece, the Netherlands, Switzerland). Before the dawn of the biosimilars it was not uncommon for a hospital in Europe to switch patients from epoetin alfa to beta or vice-versa, dependent on the outcome of the epoetin tender.
Tendering for epoetin could reduce net prices strongly, with discounts up to over 60% to list price mentioned in the public domain.21
