From this month (September), numerous generic drugs will be released in the direct-acting oral anticoagulant (DOAC) market.

Following Bayer's Xarelto (rivaroxaban), Pfizer and BMS's Eliquis (apixaban) is also facing its patent expiry.

According to industry sources on the 26th, the Ministry of Health and Welfare recently prepared a notice on the reimbursement listing of 18 pharmaceutical companies' products containing apixaban and began collecting opinions.

When looking at the DOACs that are prescribed in internal medicine hospitals and clinics, Bayer’s Xarelto (rivaroxaban), followed by Boehringer Ingelheim’s Pradaxa (dabigatran), Pfizer and BMS’s Eliquis (apixaban), and Daiichi Sankyo’s Lixiana (edoxaban) are currently the major players in Korea’s market.

Among these, Xarelto’s patent expired in the second half of 2022, and its decline in the prescription market has become more pronounced recently as domestic drugmakers have launched a slew of Xarelto generics.

According to the drug research institution UBIST, Xarelto’s prescriptions plummeted 37% from KRW 49.4 billion in 2022 to KRW 31 billion in 2023. The downward trend has continued in the first half of this year, with sales around KRW 15.3 billion.

Moreover, as another blockbuster, Eliquis, is scheduled to expire on September 10, the MOHW has announced that 18 Eliquis generics from pharmaceutical companies will be listed for health insurance reimbursement benefits.

For reference, Eliquis continues to dominate the clinical scene with prescriptions worth KRW 77.3 billion last year. In the first half of this year, it recorded KRW 38.8 billion, but this sales flow is expected to change after the launch of generics.

Upon the entry of generics, Daiichi Sankyo's Lixiana, which has recently been strengthening its market dominance, is expected to take the sole lead in the field.

Lixiana, which is copromoted and sold by Daiichi Sankyo and Daewoong Pharmaceutical, recently surpassed Eliquis’s sales and rose to monopoly.

Last year, Lixiana's domestic sales reached KRW 105.3 billion, and in the first half of this year, it recorded KRW 55.8 billion, maintaining an upward trend.

A professor of cardiology at A University Hospital said, “Nothing would notably change in the field aDOACs are well used in clinical practice. If generics are released, prescriptions will naturally be dispersed between them as they may differ in terms of drug price.”

A director of a frontline internal medicine clinic also said, “Following Xarelto, the patent expiry of major original drugs in the DOAC market has followed. I think Eliquis’s market will show a similar result to Xarelto’s. We have already been approached by sales representatives from various pharmaceutical companies requesting prescriptions from September following the launch of their respective generics.”

“I can feel the pressure put on the sales representatives by pharmaceutical companies that have launched generics. Everybody rep had been asking us to just prescribe one case,” added the director.