Provider and Payer Demand Largely Drives Biosimilar Adoption to Institution Formularies

Having a biosimilar on formulary makes it more likely the biosimilar will be adopted. Length of time a biosimilar is on market can impact how likely it is to be added to formulary.

The longer a biosimilar is available on the market, the more likely it is to be added to an organization’s formulary; however, length of time on the market does not always translate to increased utilization of the biosimilar, according to a new survey from Vizient Inc. Respondents noted that payer demand is driving biosimilar conversion.

The 2022 Biosimilar Survey included responses from hospital leaders and pharmacy professionals across the country at Vizient member hospitals. The most common reason for adding a biosimilar to the institutional formulary is provider or payer demand (30%), followed by approved review by the Pharmacy and Therapeutics committee (25%) and upon FDA approval (22%). However, 20% said there was no formal procedure.

The most likely time an institution moves to a biosimilar is when starting a new treatment (65%), but 59% said they convert individual patients based on payer demand. Approximately half (48%) also said they convert all patients over time, such as at the start of the next cycle or the renewal of prior authorization, and only 21% said they convert all patients at once, regardless of current therapy.

Half (51%) said payers prefer a specific biosimilar while 36% said payers prefer biosimilars but not a specific product. Only 21% said they consider originator products and biosimilars at parity and 13% prefer the originator product.

Among 9 products reviewed to understand how institutions have implemented automatic therapeutic substitutions, the biosimilar for ranibizumab was the least implemented, with more than 90% of respondents saying it has not been implemented with automatic substitution. Byooviz was approved in September 2021 by the FDA and only launched in the United States on June 2, 2022. A second biosimilar, Cimerli, was approved as an interchangeable biosimilar on August 3 2022, but will not launch until October 2022.

Perhaps unsurprisingly, filgrastim biosimilars are among the products that institutions were most likely to have implemented automatic therapeutic substitutions either in outpatient-only settings, inpatient-only settings, or both. There are 2 filgrastim biosimilars that have been on the market longest among all biosimilars: Granix, which was not approved via the biosimilar pathway, launched November 2013 and Zarxio launched September 2015. Institutions are also very likely to have implemented substitutions for infliximab biosimilars. The first infliximab biosimilar came to market in November 2016.

Looking ahead to 2023, when at least 7 adalimumab biosimilars will hit the market, respondents said payer placement, acquisition price, and interchangeability are the top 3 attributes for selection of an adalimumab biosimilar preferred agent. The Vizient report noted that the high number of adalimumab biosimilars expected to enter the market next year provide “an opportunity for savings for the costly therapeutic.”

Biosimilars added to formularies are more likely to be used to varying degrees. For instance, while 76% said rituximab biosimilars were added to formulary, only 69% said these biosimilars are utilized. However, when infliximab is on formulary is it highly utilized: 88% said infliximab biosimilars were added to formulary and 85% said these biosimilars are utilized.

“Vizient has long urged the adoption of biosimilars to our member healthcare organizations to compete with their branded biologic counterparts as they are just as safe and effective,” Steven Lucio, senior principal, pharmacy solutions, for Vizient, said in a statement. “The introduction of additional biosimilars signals a real savings opportunity for healthcare organizations and their patients.”

The survey was conducted between March 30 and April 28, 2022, and included 124 responses.