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Express Scripts Holding Company (ESRX), Teva Pharmaceutical Industries Ltd (ADR) (TEVA): How Obamacare’s $20 Billion Bonanza Is Bombing

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Tucked away inside Obamacare are 18 pages that could create a new $20 billion-per-year market. The section of Obamacare known as the “Biologics Price Competition and Innovation Act” authorized the creation of a pathway to approval in the U.S. for biosimilar products. These biosimilars are basically generic versions of biologics, which are drugs derived from living organisms.

While controversy continues to rage about the benefits and costs of much of Obamacare, the consensus is that the introduction of biosimilars into the U.S. should be a big plus. However, three years after passage of the act, little progress has been made. Here’s why.

Express Scripts Holding Company

Increased use of generic drugs has helped tremendously in controlling prescription drug spending. The nation’s largest pharmacy benefits manager, Express Scripts Holding Company (NASDAQ:ESRX), says that less expensive generics contributed to lower spending last year on treatments for common diseases such as high cholesterol. This marked the first time in two decades that these costs were reduced.

Despite this good news, total prescription drug spending still increased by 2.7%. Why? Americans spent more on specialty drugs, which are used in the treatment of diseases including cancer, hepatitis C, and rheumatoid arthritis. Generic alternatives aren’t available for many of these drugs, in part because some of them are biologics. The U.S. had no approval process for biosimilar versions of these biologic drugs before 2009.

However, Obamacare includes provisions that authorized the secretary of Health and Human Services to establish a pathway for approval for biosimilars. The measure was one of the few parts of the law that garnered broad bipartisan support in the House and Senate. Both major political parties appeared to realize the potential for biosimilars to help control medication costs over the long run.

IMS Health projects that the U.S. market for biosimilars should generate $20 billion annually by 2020. This baseline assumes that biosimilars will comprise 8% of the total biologics market by that point. IMS Health thinks that growth could possibly surpass this level, with biosimilar sales of more than $25 billion by 2020.

Express Scripts Holding Company (NASDAQ:ESRX) seems poised to be a winner with the growth of biosimilars. Like other pharmacy benefit managers, or PBMs, the company makes higher profits on generic drugs compared to brand drugs. While biosimilars won’t be as profitable as these generics, increased availability of biosimilars could open up new avenues for Express Scripts Holding Company (NASDAQ:ESRX) to boost earnings.

Companies that successfully launch biosimilars should also reap the benefits of the new approval pathway. IMS Health’s study published in late 2011 about the potential for this new market highlighted Teva Pharmaceutical Industries Ltd (ADR) (NYSE:TEVA) as a prime example of one of these potential success stories. Teva currently ranks as one of the leading makers of generic drugs.

The heralded bonanza hasn’t materialized yet, though. While a handful of “follow-on biologics” have been approved by the Food and Drug Administration, so far no biosimilars have gained approval through the pathway authorized by Obamacare.

Teva Pharmaceutical Industries Ltd (ADR) (NYSE:TEVA) did get FDA clearance for marketing Neutroval, a biosimilar for Amgen, Inc. (NASDAQ:AMGN)‘s Neupogen. However, that approval came through the already-established Biologic License Application, or BLA, process rather than the newer biosimilar pathway introduced in Obamacare.

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