US Physician-Administered Drug Market Overview

This is the first in a series of posts in which BluePath will explore biopharmaceutical pricing dynamics as they relate to the physician-administered drug (PAD) market in the US.  PAD biopharmaceuticals are generally those drugs furnished incident to a physician’s services and/or require administration by a healthcare professional.  These drug types may include, but not be limited to the following:

• Infused, injectable, and select vaccines
• Drugs covered by statute (some vaccines and oral anticancer drugs)
• Drugs administered with a covered item of durable medical equipment (e.g., inhaled drugs delivered via a nebulizer)

In this first post, we will explore the structure of the PAD market.  For the purposes of this report, we will  focus on drugs that have been assigned specific J or Q codes and have been included in the CMS Average Sales Price files at some point through their product lifecycle.  The number of available products is based on data from the fourth quarter of each calendar year. 

All analyses were conducted with Pricescape, a proprietary BluePath market intelligence tool which explores the landscape of PAD net drug pricing in the US market.   

PAD Market Overview

As seen in Figure 1 below, the number of products with J codes was fairly flat in the time period between 2006 – 2016.  In 2006, 447 products had J codes and 36 had Q codes, accounting for a total of 483 products, including both brand and generics. 

Beginning in 2017, the number of products with J codes accelerated and grew to a total of 638 in 2024.  The number of products with Q codes followed a similar pattern and grew to a total of 55 by 2024.  This brought the total PAD market size to 693 products with specific J or Q codes in 2024.

Between 2006 – 2024, the total number of products with J or Q codes grew 43%.  This aligns with trends indicating a general upward increase in the number of novel drug approvals since the early 2000’s.  An additional factor contributing to this change is the shift in drug development towards biologics and targeted therapies for cancer and rare diseases, drug types that often require physician administration. 

Figure 1.  PAD Products with J & Q Codes (2006 – 2024)

Composition of the PAD Market

BluePath also evaluated the PAD market by drug type.  For the purposes of this analysis, three different drug types were identified:

• Brand
• Generic
• Brand & Generic

BluePath used data fields from Redbook to make the drug type assignment.  Drugs with a brand & generic designation generally had a mix of NDC’s which varied by drug type (e.g., some NDCs labeled as brand while others were generic).

Drug types were evaluated over the 2019 – 2024 time period.  As seen in Figure 2, brand drug types account for either the plurality or majority of Healthcare Common Procedure Coding System (HCPCS) codes in the PAD market. 

Figure 2.  Number of HCPCS by Drug Category Type

In 2024, 55% of drugs with a specific HCPCS code were brand drugs.  The increase in brand drugs over the time period measured was 22%, with most of the growth occurring in the years between 2022 – 2024. 

An additional market dynamic which impacts PADs was the continued evolution of the biosimilar market.  As more brands were subject to patent expiry, there was a notable increase in the number of biosimilar therapies.  Figure 3 below shows that PAD reference brands which have biosimilar competitors expanded to 27 by the end of 2024 –  an increase of 145% between 2019 – 2024 (the number of biosimilars seen in Figure 3  is specific only to those which are or have been commercially available on the US market and reported ASP pricing). 

Figure 3.  Number of PAD Biosimilars

Implications for Manufacturers

The growth in PAD brands suggests that competition in select therapeutic classes has increased over time.  This competition may take many forms which include PAD brands vs. PAD competitors or PAD brands vs. self-administered competitors within the same therapeutic class.  In addition to competition between brands, the emergence of biosimilars has added a new dimension to the competitive landscape of the PAD market. 

Rising competition from brands and biosimilars in certain PAD therapeutic classes has led to a situation where increased brand net price concessions may be expected on the part of manufacturers.  Growing price competition among PAD brands has been amplified by the emergence of medical rebate aggregators who seek to lower prescription drug costs by securing price concessions on medical benefit drugs – companies such as Synergie Medication Collective, Anton Rx, and Remedy One are actively managing select PAD therapeutic classes and encouraging increased price competition.  

Thus, net price competition in the PAD market is on the rise and manufacturers should actively monitor net price differentials between their brand and competitors to ensure brand access is not being potentially compromised by competitor net price actions.  BluePath will evaluate PAD net price competition by specific therapeutic classes in future blog posts to follow.

Questions or inquiries on the latest in physician-administered drug net price or other market access trends? Please contact us at info@bluepathsolutions.com