Drug Prices to Continue Upward Trend Even as Biosimilars Enter the Market

The overall drug price inflation rate is forecasted to be 3.78% for the calendar year beginning July 1, representing a growing upward trend led by increases in prices and utilization, according to Vizient’s Pharmacy Market Outlook Winter 2023.

The top drug by total spend for Vizient members from October 2021 to September 2022 was adalimumab (Humira), followed by pembrolizumab (Keytruda) and ustekinumab (Stelara). Among the top 15 drugs by total spend, there were 2 with multiple biosimilars on the US market: infliximab (12) and pegfilgrastim (15). In addition, the number 9 drug was etanercept, for which there are 2 biosimilars approved, but they will be unable to launch in the United States until 2029 due to patent litigation.

According to the report, pegfilgrastim is new to the top 15. The drug, which is used for the prevention of chemotherapy-induced neutropenia, had a 3% wholesale acquisition cost price increase. In addition to the price increase, Vizient noted there has been slightly more use of the therapy.

For the calendar year starting July 1, adalimumab is projected to have the largest price increase. “Of course, mitigation of the price increase for the top spend drug adalimumab can be addressed in 2023 due to the introduction of biosimilars,” the report stated.

The launch of the adalimumab biosimilars in the United States is 1 of 5 key areas of focus in 2023, according to the report. “Adalimumab has been one of the top spend medications for health systems for the past decade and the availability of several biosimilar products represents a significant opportunity to lower pharmaceutical expenditures,” Vizient reported.

Regarding adalimumab, the report notes that the formulation of the product matters. Patient prefer the citrate-free formulation because it causes less injection site pain. In addition, the high-concentration formulation allows for a smaller injection volume. According to Vizient provider data, 12% of adalimumab formulations are the non–citrate-free and/or low-concentration version.

Amjevita is the first adalimumab biosimilar to launch and while it is citrate free, it is also low concentration. Vizient predicts that the utilization of this first biosimilar is likely to be minimal, as a result of the preference for the high-concentration formulation. Later in the year, there are citrate-free, high-concentration biosimilars launching, which are expected to be more favorable.

Another consideration is the device used to deliver the product. Humira is available through an autoject pen, prefilled syringes, and vials. The autoject pen accounts for 90% of the Vizient member spend, and 7 of the anticipated 10 upcoming adalimumab biosimilars in 2023 will have the autoject pen device available. Hadlima, which is anticipated to launch July 1, may have an advantage because it offers a device that delivers the medication when the entire pen is pressed into the skin, which may be beneficial for patients with dexterity issues.

When adalimumab biosimilars launch, payer preference will have a large impact utilization of various biosimilars. Payers may prefer a biosimilar and exclude the originator, prefer both the originator and a biosimilar, or prefer the originator and exclude biosimilars. The last scenario will result in much slower uptake of biosimilars.

“Stakeholders are eagerly anticipating the impact of biosimilar competition entering the market this year, but payer preference will also impact the utilization of biosimilars,” Carina Dolan, Vizient assistant vice president of clinical oncology, pharmacoeconomics, and market insights, said in a statement. "If payers designate the biosimilar and the originator product as co-preferred, we think a faster uptake of a biosimilar product is possible."

The other areas of focus are drug shortages, which are an enduring challenge in all care settings; innovative medication approvals; creating a resilient workforce; and the continued expansion of ambulatory care.