A lack of transparency and misaligned incentives had curtailed the adoption of biosimilars in the United States.
The promise of large savings due to the use of biosimilars has been stymied by barriers to adoption; however, there are actions employers can take to overcome these obstacles, according to a report based on a series of roundtables with employers.
The National Alliance of Healthcare Purchaser Coalitions (National Alliance) brought together 7 regional coalitions and more than 60 employers and compiled the findings and recommendations in the Improving Drug Management: Employer Strategies on Biosimilars report. The effort was funded by the Biosimilars Forum.
There are projections that greater adoption of approved biosimilars in the United States could save billions—possibly up to $133 billion over 4 years, according to a report from the Association for Accessible Medicines.
“The US lags Europe in embracing and expanding the biosimilars market,” Michael Thompson, National Alliance president and CEO, said in a statement. “Educating plan sponsors about barriers to broader adoption of biosimilars will enable them to challenge the market dynamics blocking this critical channel to achieve a more competitive drug market.”
The recommendations in the report fall into 5 main areas.
Plan design. Some employers raised concerns that adding biosimilars and biologics might create confusion if treatment was interrupted as a result of reimbursement restrictions. The report recommends that employers create an additional tier or preferred reimbursement for biosimilars and biologics or add the products to the branded tier.
Formulary design. The employers noted they had a standardized formulary and customizing it to add biosimilars and biologics would incur a significant fee, but the report noted there is “no defensible reasons biosimilars cannot be added to the formulary.”
Drug pricing and rebates. Some employers said they were told biosimilars/biologics were less safe and more expensive, and therefore, unnecessary to add to the formulary. They were also concerned they would lose rebates by switching from branded products to biosimilars. However, research has shown biosimilars and biologics should result in price decreases of 15% to 30%, which should save the plan money even after losing rebates.
Biosimilar availability. Patients could encounter delays due to biosimilars and biologics not being available in inventory, but the lack of biosimilars is due to them not being on formulary, not because the dispensing pharmacy lacks the inventory, according to the report.
Site of care and drug administration. Employers do not have a clear view of how they are charged for infusion fees, and they do not understand the actual total cost of care with biosimilars.
“Unlike generic drugs, which are available to 90% of patients, lower cost biosimilars are only available to 20% of the patients who need them,” said Juliana M. Reed, executive director of the Biosimilars Forum. “Biosimilars are critical to lowering the cost of drugs in the US, and these findings make it crystal clear that policy makers can achieve billions in healthcare savings by increasing biosimilar adoption and access.”