The applicant's evidence and submissions
122 On this aspect of the application, the applicant's submissions were based principally on the evidence given by Mr Yager, Mr Jones and Mr Geelan.
123 The applicant submitted that listing the Mylan products on the PBS Schedule and launching them in Australia would cause extensive, irreversible damage to the applicant and Janssen-Cilag. It contended that this damage would be difficult to quantify and attribute. It said that this loss will be manifested in, principally, a loss of sales value and a loss of market share for the PREZISTA and PREZCOBIX products.
124 With respect to loss of sales value, the applicant submitted, firstly, that the price at which Janssen-Cilag would be able to sell PREZISTA will be immediately reduced by 16% and the price at which it would be able to sell PREZCOBIX will be immediately reduced by 11%. This is a consequence of the operation of the PBS which lists medicines according to one of two formularies. Formulary - F1 comprises single branded medicines that are not interchangeable with other branded medicines at the patient level. Formulary - F2 comprises multi-branded medicines that are interchangeable at the patient level due to their bioequivalence (or bio-similarity). PREZISTA and PREZCOBIX are currently listed in the F1 formulary. If a medicine moves from F1 to F2, an immediate statutory minimum 16% reduction is applied to the "Approved Ex-Manufacturer Price" (AEMP). In the case of PREZCOBIX, this reduction would be approximately 11% because the price reduction would be applied to the component of the AEMP attributable to darunavir. The applicant's evidence was that this reduction would be, for practical purposes, irreversible. Mr Yager said that he is not aware of any case in which the price of a product listed on the PBS has been restored to its previous levels after the withdrawal of a competing generic product. Whilst noting that the Minister does have a discretion under s 85AD(1) of the National Health Act 1953 (Cth) (the NHA) to enter into new price agreements in such circumstances, Mr Gupta also acknowledged that he is not aware of any case in which the price of a product has been restored to its previous levels after the withdrawal of a competing generic product from the PBS.
125 Janssen-Cilag has another relevant HIV medication in its commercialisation pipeline for possible future distribution and sale in Australia (the new product). Should this product be brought to market, it would also be subject to a percentage reduction calculated by reference to its darunavir component.
126 If the statutory price reduction were to be implemented, Janssen-Cilag could impose a brand price premium for its products but, as explained by Mr Jones, it would be commercially unviable for it to do so because the premium (which in the case of PREZISTA and PREZCOBIX would be very substantial in order to be meaningful commercially) would have to be borne by the consumer.
127 Secondly, the applicant submitted that the price at which Janssen-Cilag would be able to sell PREZISTA and PREZCOBIX will likely be further reduced substantially over time because of a number of market factors. There is evidence that suppliers of generic pharmaceuticals, like the respondent, typically offer very substantial discounts (including rebates) to pharmacists on their generic products as part of a sales strategy. The applicant argued that the respondent would be able to sell the Mylan products more cheaply than Janssen-Cilag's PREZISTA and still make a profit due to the much lower cost base for those products.
128 Thirdly, the applicant submitted that should the respondent enter the market, it is very likely that other generic suppliers will quickly follow suit. It submitted that the entry into the market of additional generic suppliers in respect of the same product would cause rapid and substantial further price erosion as the generic products and the PREZISTA and PREZCOBIX products compete with each other in (what Mr Yager described as) a "downward price spiral". I note, in this connection, the respondent's acceptance, through Mr Gupta's evidence, that the darunavir market is of sufficient overall value, especially in the context of PBS-listed products, to be attractive to other generic pharmaceutical suppliers.
129 Fourthly, the applicant submitted that the PBS mandatory price disclosure mechanism will further drive down the maximum price at which all darunavir products in the market may be sold. To explain, under the NHA the sponsors of drugs listed under the F2 formulary must disclose to the Department of Health's Price Disclosure Data Administrator certain data in relation to the products sold to wholesalers, community pharmacies and private hospital pharmacies. This data is then used to determine the "weighted average disclosed price" (WADP) of the listed items. The calculation takes into account the actual ex-manufacturer price or net selling price of all relevant brands and the disclosed revenue generated by those brands in relation to sales to wholesalers, community pharmacies and private hospital pharmacies. There are two variables that influence the calculation: the market share of generic and originator products, and the level of incentives provided by the generic and originator suppliers to their customers. If the WADP is at least 10% less than the AEMP in a given period, then the AEMP will be adjusted downwardly, thereby effecting a further reduction in price for the listed products. In this equation, the greater the market shares of the generic products, and the greater the rebates or discounts given in respect of those products, then the greater the reduction in the WADP and therefore the greater the reduction in the AEMP. The first potential price-disclosure related price reduction day for a drug listed on 1 December 2017 would be 1 April 2019. Following that, price reductions could occur every six months, depending on whether the WADP threshold is reached.
130 Mr Gupta pointed out that the WADP does not include sales made to public hospitals. Mr Jones responded that, while this is so, it does not follow, as Mr Gupta argued, that the price disclosure cuts in the present case are likely to remain lower than for other drugs sold primarily to wholesalers, community pharmacies and/or private hospitals, and significantly closer to the current PBS price for PREZISTA. This is because all sales and discounts to retail pharmacies, wholesalers and private hospital pharmacies are included in the calculations of the WADP and are the only market segment used for this purpose. The fact that public hospitals are excluded from the WADP calculation is not to the point because, if the WADP calculation results in a price disclosure based price cut, that price cut applies to all PBS listed darunavir products, including those sold to public hospitals.
131 I should record that, as a result of amendments to the NHA in 2015, and further impending changes, drugs that remain on the F1 formulary are subject, in any event, to periodic mandatory price reductions depending on the time they remain on the PBS. PREZISTA and PREZCOBIX were subjected to a price reduction of 5% on 1 April 2016. They will be subjected to a further price reduction of 10% on 1 June 2018, if they remain on the F1 formulary (if, for example, the Mylan products are not listed on the PBS on 1 December 2017).
132 With respect to loss of market share, the market can be divided between the hospital market segment and the retail pharmacy segment (as I noted at [9] above). The entry of a generic darunavir product will likely cause loss of market share for Janssen-Cilag in both segments, with consequential loss to the applicant.
133 In the hospital segment, hospitals will pay the PBS list price for a product that has exclusivity. When a generic competitor enters the market, and the exclusivity for an innovator product is lost, tenders are called by the State or Territory authorities that have responsibility for the supply of medicines to public hospitals in their respective jurisdictions. The applicant submitted that if the Mylan products enter the market, it is likely that the seven State and Territory hospital tendering authorities will call for tenders in relation to PREZISTA within months. In that event, the purchasing decision of each authority is likely to be based on price, and nothing else. If, for example, the respondent were able to secure the contracts for supply in New South Wales and Victoria with the Mylan products (because of substantial price discounting) then that would represent a very substantial loss in market share for Janssen-Cilag, with consequential loss to the applicant. To avoid this consequence, it would be necessary for Janssen-Cilag to engage in significant discounting from its current price, in order to be price competitive. The position would be exacerbated by further generic entry which could result in further tenders being called to take account of the availability of increased price competition from the new entrant(s). Mr Yager expressed the opinion that such tenders were likely to be called as soon as a second generic supplier comes to the market, which could be early 2018. Mr Gupta disagreed: see below at [155]-[156].
134 In the retail pharmacy segment, there is evidence that a substantial percentage of privately-owned pharmacies are likely to conduct an "unofficial tender" process in relation to PREZISTA shortly after the entry of a generic equivalent product. Once again, it seems likely that, in such a process, price will be the determining factor.
135 The applicant also submitted that Janssen-Cilag will suffer market share loss in respect of the PREZCOBIX product because, even though the respondent is not bringing a generic PREZCOBIX product to market, the volume of PREZCOBIX sales is likely to be affected in the hospital segment because hospitals are likely to be motivated to prescribe the cheaper Mylan products with a separate PK booster tablet, rather than pay a higher price for PREZCOBIX. There is evidence that 80% of Janssen-Cilag's sales of PREZCOBIX are in hospitals.
136 In previous paragraphs, I have referred to the loss to Janssen-Cilag, with consequential loss to the applicant. There is confidential evidence before me concerning the commercial relationship between the two companies, particularly in relation to profit-sharing on the sales of PREZISTA and PREZCOBIX in Australia. Based on that evidence, I am satisfied that the applicant would suffer substantial loss of profit should the Mylan products come into the Australian market.
137 Janssen-Cilag would also suffer loss in this regard, which would be significant to its business. Based on its current business model, the effect in relation to Janssen-Cilag would be a need to reduce marketing expenditure and medical support expenditure, including by cutting staffing levels. Mr Yager gave evidence that such reductions would adversely affect the goodwill that Janssen-Cilag enjoys among medical practitioners, customers and other participants in the Australian pharmaceutical market, particularly in the HIV medication market. He also said that these reductions would inevitably reduce the scope and scale of the marketing and pipeline commercialisation measures which Janssen-Cilag could undertake in Australia.
138 In this latter regard, the applicant led evidence about the new product. Mr Yager said that, if the Mylan products were to be listed on the PBS and enter the Australian market, the viability of commercialising the new product would be "severely compromised". On the basis of the confidential evidence before me, I am satisfied that this consequence would be a real likelihood. The likely impact would extend beyond the applicant and Janssen-Cilag, to the Australian public.
139 Finally, the applicant submitted that the respondent has proceeded with its eyes wide open and, because the principal proceeding was commenced before mid-November 2017, could have chosen not to proceed with its PBS listing.