A poster from AMCP Nexus quantifies trends in biosimilar coverage within Tufts Medical Center, finding that payer coverage of these products has increased but individual preferences among payers still vary.
Research presented at the Academy of Managed Care Pharmacy’s annual Nexus meeting demonstrated that although coverage of biosimilars has been on the rise since 2017, payer product preferences and number of covered claims for biosimilars still vary.
The study, conducted by the Center for the Evaluation of Value and Risk in Heath at Tufts Medical Center, sought to address concerns that despite a growing number of biosimilars on the market, uptake has been slow, largely because reference agents tend to be placed on higher payer formulary tiers than biosimilar versions. The researchers also evaluated how trends in coverage is reflected in market share and net pricing trends.
Data from 2017 to 2022 were pulled from the Tufts Medical Center specialty drug evidence and coverage database, which includes information on specialty drug coverage decisions issued by 17 large US commercial payers. Real-world data were collected from IQVIA’s longitudinal access and adjudicated dataset and PharMetrics Plus database, which included deidentified claims-level market share data for all originator product families. CMS’ average sales price (ASP) quarterly payment was used to identify market-based pricing that reflects average manufacturers’ ASP after rebates and discounts. A pricing databased was used to obtain wholesale acquisition cost (WAC) data.
Seven originator products marketed as of August 2022 across indications with at least 1 biosimilar with FDA approval were assessed. The results showed the payer policies with originators as the sole preferred product decreased from 56% in 2017 to 8% in 2022.
Additionally, policies where more than 1 product was preferred rose from 30% in 2017 to 75% in 2022, with 92% of policies including at least 1 biosimilar as a first-line option.
In 2022, 1 payer did not cover any originator product facing biosimilar competition as a first-line therapy, and 16 payers varied (3% to 89%) in the frequency of coverage of originator products among preferred treatments.
“Payer policies are facilitating a competitive market, reflected by a growing number of biosimilars and a gradual rise in biosimilar market shares,” the researchers wrote.
Market Share Analysis
By the end of the third year post-launch of the first biosimilar, the market shares for biosimilars surpassed that of originators. However, the average individual biosimilar market share has not exceeded 20% at the 4 year mark after the first biosimilar launch.
WACs of the originator and biosimilar markets dropped to 91% of the competition value prior to biosimilar market entrance. Also, ASPs for originators and biosimilars dropped to 63% over an average of 4 years after initial biosimilar launch.
“The low individual biosimilar market shares is in part due to multiple biosimilar entry, providing evidence of the greater market competition brought on by biosimilars. Despite concerns of slow biosimilar uptake, the market appears to be functioning competitively as is evident by the decline in ASP of the market, which should result in cost savings in the long run,” the researchers explained.
Reference
Beinfeld MT, LaMountain F, Wong WB, Kim E, Chamgers JD. Trends in US commercial health plan coverage of biosimilars. Presented at: AMCP Nexus; October 16-19, 2023; Orlando, Florida. Poster: U17.
Cencora Analysis Shows Differences in Payer Coverage Between G-CSF Biosimilars
May 2nd 2024Data from a Cencora study showed some misalignment in payer coverage of granulocyte colony-stimulating factor (G-CSF) biosimilars, highlighting that while filgrastim biosimilars are often favored over the originator, reference pegfilgrastim still dominates over its biosimilars.
What AmerisourceBergen's Report Reveals About Payers, Biosimilar Pricing Trends
May 28th 2023On this episode of Not So Different, Tasmina Hydery and Brian Biehn from AmerisourceBergen discussed results from a recent survey, that were also presented at Asembia 2023, diving into the payer perspective on biosimilars and current pricing trends across the US biosimilar industry.
Eye on Pharma: EU Ustekinumab Approval; New Golimumab Data; Evernorth Adds Humira Biosimilar
April 29th 2024The European Union gained a new ustekinumab biosimilar; Alvotech released positive results from a clinical trial evaluating a golimumab biosimilar and the reference products (Simponi and Simponi Aria), and Evernorth announced that it is set to cover an adalimumab biosimilar at zero cost to patients.
Pipelines and Preparation: How the US Can Prepare for More RA Biosimilars
April 16th 2023What can practices do to prepare for all the biosimilars to treat rheumatoid arthritis (RA) coming down the pipeline? And how can they ensure that the lower-than-anticipated adoption rates for infliximab biosimilars are not repeated? Robert Zutaut, RPh, from McKesson Provider Solutions, tackles all this and more on this episode of Not So Different.
AON Saves Over $243 Million With High Biosimilar Adoption
April 22nd 2024Thanks to high biosimilar adoption rates within the community oncology setting, American Oncology Network (AON) saved upwards of $243 million between 2020 and 2023, according to a presentation at the Festival of Biologics USA conference in San Diego, California.
The 6 Key Policy Factors to Ensure Biosimilar Market Sustainability
April 16th 2024Magnus Bodin, senior director and head of international access and policy at Biogen, presented warning signs for unsustainable biosimilar markets as well as key factors needed to create effective policies and future-proof biosimilar markets globally.