Panel: Biosimilar Acceptance May Be Greater Among Payers Than Previously Thought

Payers were found to be more accepting of biosimilars than expected, according to survey results presented during a panel discussion at the Academy of Managed Care Pharmacy’s 2021 Nexus meeting.

The panel discussed the current trajectory of biosimilar adoption, barriers to adoption, and how coverage of biosimilar is anticipated to evolve in the coming years.

Tasmina Hydery, PharmD, MBA, BCGP, assistant director of integrated delivery solutions at AmerisourceBergen/Xcenda, talked about the anticipation surrounding the launches of the 6 FDA-approved adalimumab biosimilars, which are scheduled to enter the US market in 2023, and the interchangeable formulation of Semglee (insulin glargine), the first biosimilar to be approved in the United States.

Hydery mentioned that reactions to the potential for interchangeable biosimilars have been positive; however, states have enacted their own laws, which has caused confusion among payers, patients, and providers on whether interchangeability designations will have an impact.

“Some of the FDA leaders have noted that there's potential for cost savings, there's more competition in the marketplace, and now there's potentially more access to affordable products. But there are others that are speculating whether this will actually translate into uptake and how important it is to educate pharmacists about the different state laws and how pharmacies will actually operationalize the availability of the interchangeable biosimilars,” said Hydery.

Another challenge for biosimilar uptake concerns patent thickets, which Congress is working to address, according to Hydery. She said that by limiting the number of continuation and divisional patents that can be filed for a single patent and capping the number of patents that could be asserted against a biosimilar product, Congress could prevent future patent thickets.

Cate Lockhart, MS, PharmD, PhD, executive director of the Biologics and Biosimilars Collective Intelligence Consortium, delved into the existing research on coverage, adoption, and utilization patterns of biosimilars, saying that survey results show that among 17 of the largest commercial health plans in the United States, only 14% cover biosimilars as preferred products.

Lockhart also explained how filgrastim biosimilar Zaxio (filgrastim-sndz) is listed as a preferred product on coverage plans 51% of the time, which is much higher than infliximab-abda and infliximab-dyyb (0% and 5%, respectively). Additionally, she said that although biosimilar uptake has been slow, regression models estimate that the market share of reference products would decline by about 0.38% to 0.46% for each month a biosimilar is available.

However, despite uptake being on the rise, only 35% of payers are continuing cover all biosimilars, according to Jennifer Snow, MPH, vice president of reimbursement policy insights at AmerisourceBergen/Xcenda. Health plans (48%) and pharmacy benefit managers (22%) were most likely to cover all biosimilars whereas 100% of integrated delivery networks surveyed said they only cover some biosimilars.

Overall, Snow said that 59% of payers agreed that biosimilars have provided their organization with meaningful cost savings. Most surveyed payers said that they contract with biosimilar manufacturers for select biosimilars and that they would cover the biosimilar for the same indications as the reference product (75% and 55% respectively), regardless of whether the indications were approved by the FDA.

Snow proclaimed that the statistics that surprised her most were that 96% of the surveyed payers agreed that biosimilars are safe and effective for treatment-naive patients and that 92% agreed that switching to a biosimilar from a reference product was safe and effective. Cost savings were also cited as the most important factor driving the adoption of biosimilars, with 65% of payers ranking it as their top influencing factor, followed by 27% who chose interchangeability status as their top influencing factor.

Lockhart noted Kaiser Permanente’s success in obtaining substantial biosimilar uptake, achieving a 95% utilization rate for filgrastim-sndz and 80% rate for infliximab-dyyb, both much higher than the national average (32% and 3%, respectively). Lockhart said they were able to achieve such numbers by adopting the biosimilars shortly after they received FDA approval.

Finally, Lockhart explained that despite biosimilar adoption having a slow start, the United States is starting to see increased utilization, with less lag times between approval and launch. Additionally, many managed care settings are seeing success by implementing strategies to encourage biosimilar use and are anticipating pharmacy benefit biosimilars and identifying potential formulary strategies.

“There's a lot of hope and there's a lot of people who I think are really invested in doing this, because we want patients to get access to the medications they need at a cost they can afford. And we've seen some successes with that,” said Lockhart.