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.
Ensure access to biosimilars and put biomarker testing in place to confirm appropriate drugs
Ensure plan design is based on a value-based approach with strategies to improve high-value care
Review co-pay tiers and consider strategies that limit a patient’s cost
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.”
Consider a custom formulary design
Request an audit of the current formulary
Require all new biosimilars be placed in the generic tier of 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.
Consider an approach that reduces or eliminates rebates
Require full pass-through in contracts or start over with a transparent or pass-through pharmacy benefit manager
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.
Include all biosimilars on formulary and offer incentives for the use of biosimilars over reference products
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.
Include options for infusion or ports in plan designs as these are advances in drug delivery
Collaborate with local health systems to address sites of care
“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.”
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