OnCo
ideasIdea

WHO prequalification plus pooled demand to push biosimilar prices below 10% of the originator

Cheap copies of key antibody drugs exist but many countries cannot check their quality. A WHO quality stamp plus large pooled orders would make them safe to buy and very cheap.

Biosimilars of trastuzumab, rituximab, and bevacizumab have been on the market for years, but uptake in LMICs is limited by regulatory capacity to assess biologics, fear of poor-quality products, and small, fragmented orders. WHO prequalification of biosimilars began with trastuzumab in 2019. Extending prequalification to the full oncology biosimilar set and coupling it with pooled procurement (through PAHO's Strategic Fund, UNICEF, or a new mechanism) would give buyers assurance and manufacturers volume.

Hypothesis
Prequalified biosimilars purchased through a pooled mechanism will be available in at least 20 additional low-income countries within three years at prices below 10% of the originator's high-income list price.
Rationale
Prequalification did this for HIV antiretrovirals and vaccines; biologics are more complex to assess, but the assessment is done once and used by many.
What would test it
Track prequalification throughput, participating country count, price per vial, and share of eligible patients receiving trastuzumab for HER2-positive breast cancer in participating versus non-participating countries.
Maturity
early clinical
Who has to act
regulator
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
  • Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
  • Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.
  • Regulatory divergence between regions · Regulatory divergence means a drug approved in one country can take years to reach another, or never arrive.

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