With seven anti-PD-(L)1 drugs available in the US it is remarkable that there is virtually no competition on price among their makers. Neither have certain players’ moves to rectify the situation amounted to more than empty words.
Step forward EQRX, a private US biotech promising “radically lower prices” that at Asco presented data on what could become its first cancer drug. If that meeting’s message of equity fell short of expectations, EQRX promises real action, and in an interview with Evaluate Vantage reveals that it would seek to undercut an established cancer drug by as much as 75%.
While stressing that until EQRX has an approval any discount discussed is just theory, the group’s chief operating officer, Melanie Nallicheri, cites a hypothetical cancer drug costing $200,000 per patient per year in the US and €100,000 in the EU. “We may end up pricing at $50,000,” she states. “That is an example of what we mean by ‘radically lower’.”
Not a charity
Of course EQRX is not a charity, and has never sought to portray itself as one. Ms Nallicheri makes no secret of wanting to build a sustainable, profitable enterprise that by the end of the decade will have launched 10 or more drugs, with “tens of medicines in development”.
This goes to the heart of EQRX’s business model, which is fundamentally based on scale. While launching one discounted drug would set a wonderful example, Ms Nallicheri says, the only way to drive through the massive efficiencies she has in mind is by doing this with a large portfolio.
And, though lowering prices is “absolutely” central to EQRX’s mission, this is not where it starts; the foundation is products with efficacy equal to or better than the competition. While pharma traditionally tries to “push” drugs through a large sales force, EQRX wants to get “pull” from prescribers by developing medicines offering a clinical as well as a price benefit, thus spending much less on sales and marketing.
As an example, Ms Nallicheri cites aumolertinib, the lung cancer project on which EQRX presented data at Asco: “Even absent pricing it’s a great medicine. As a physician you would want to consider it as an option.”
Either aumolertinib, a Tagrisso competitor licensed from Jiangsu Hansoh, or sugemalimab, an anti-PD-L1 licensed from Cstone, could become EQRX’s first approved drug. The pipeline also includes the Cstone-originated anti-PD-1 CS1003, and lerociclib, a CDK4/6 inhibitor from G1 Therapeutics.
One criticism might be that in the Asco trial aumolertinib was compared not against Tagrisso but against the first-generation EGFR inhibitor Iressa. Ms Nallicheri says this is in line with the design of the study that gave Tagrisso its front-line label, asking rhetorically: “Where do we actually, in our industry, see head-to-head studies?”
EQRX is not the first company to seek to compete on price. Fortress Biotech’s listed Checkpoint Therapeutics subsidiary has long said it wants to “enter the [anti-PD-L1] market at an attractive price point to gain market share”, and more recent presentations have suggested a 20-30% discount to peers as a market-disruptive strategy.
Coherus’s stated mission is “to increase patient access to cost-effective medicines ... to deliver significant savings”, and its own anti-PD-1 MAb, toripalimab, also featured at Asco. But Coherus has shied away from radical action, opining in a recent presentation that the anti-PD-(L)1 market is not one “in which you go in with steep discounts and attempt to price-cut your way into market share”.
And Asco itself, while paying lip service to “Equity: every patient. Every day. Everywhere”, appeared vague as to what would amount to a significant discount for patients, and how this could be achieved, at least at this year’s meeting.
Ms Nallicheri says fears about empty words are warranted, but insists that EQRX is leading the way. More licensing deals will be sought, in China and elsewhere, and discounting across markets, to achieve a more even global price, is the goal. “We’re only getting started,” she promises.
The stress has to be on great drugs, and EQRX does not want to trade lower safety or efficacy for a lower price tag. But “price is a core component, and must be front and centre of the conversation”, she says. “We will follow through.”
This story has been updated to correct the ownership status of Checkpoint Therapeutics, and that company's statements about possible pricing discounts.