When Bristol-Myers Squibb unveiled its price for Opdivo in China, industry watchers considered it a benchmark against which future immuno-oncology therapies will look to for their pricing strategies.

Now it appears at least its arch rival, Merck & Co., has taken note for PD-1 competitor Keytruda.

The New Jersey pharma has priced Keytruda at 17,918 Chinese yuan ($2,600) per 100mg/4mL vial in China on the retail front, local business media organization Caixin reported. Compared with the drug’s U.S. price of around $4,800, that’s a 46% discount—about the same taken by Opdivo—and is also about 70% of its Hong Kong, S.A.R., China price.

In addition, Merck is rolling out a patient assistance program (PAP) that will offer patients three additional months of free treatment after they pay for the first three, according to Caixin. Opdivo’s reported PAP entails six months of free drugs after five.  

BMS’ price for Opdivo was first made known in August, about two months after it became the first immuno-oncology agent approved in China. Its retail price is set at about $1,350 for the 100mg/10mL vial, nearly half the U.S. cost of approximately $2,600.

Keytruda was approved in the emerging market in late July. While Opdivo directly went after the lucrative lung cancer market for its first China indication, Keytruda is now approved there in advanced melanoma, even though it has already shown the ability to slash lung cancer death risk by half when paired with chemo in first-line use.

Lung cancer is the most common tumor type in China, with a total incidence of about 733,300 new cases a year, according to an official count for 2015. In comparison, melanoma only posted 8,000 new diagnoses in the country that year.

The difference in indications will probably limit Keytruda’s initial uptake. Of course, there will be off-label uses for both drugs. But PAPs and future insurance coverage, if any, will be restricted to approved indications only. Because the two drugs’ costs—as with almost all innovative cancer drugs—are way above a person’s disposable income on average in the wealthiest cities of China, financial assistance will be key in ensuring their access.

Both drugs will likely have a hard time getting onto the country’s national insurance scheme. For one thing, their costs might still be a burden on healthcare expenditure after steep discounts; second, Professor Yilong Wu, who led Opdivo’s Chinese-specific phase 3 trial, has said PD-1s are less predictive of the most suitable patients compared to targeted therapies, meaning the government will likely favor the latter for coverage.

In the second quarter, Keytruda overthrew Opdivo as the new PD-1/L1 king, with $1.67 billion in quarterly sales, versus Opdivo’s $1.63 billion.

Several domestically made checkpoint inhibitors might soon join the fray. Junshi Biosciences has also filed its PD-1 for approval in melanoma, and Jiangsu Hengrui Medicine and Innovent Biologics await Chinese decisions as well.

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