“Do I think these numbers are reasonable and achievable? Potentially,” said Christina Corridon, MPH, MBA, a principal with the consulting firm ZS.
Last month, the Biosimilars Forum released a proposal that it said could save the United States and taxpayers billions of dollars in Medicare Part B, depending on which changes Congress decided to make, such as creating new innovation models, using a shared savings program, or upping add-on payments.
The industry group said it commissioned a scoring analysis from Avalere Health examining options that could potentially reduce out-of-pocket costs (OOP) and federal spending in the range of $1.9 billion to $5.2 billion between 2020 and 2029, and cut beneficiary costs by $2.2 billion to $3.3 billion.
The estimates vary based on the underlying assumptions used, and they vary widely. In that sense, it is similar to other reports that have strategized ways to increase the uptake of biosimilars in the United States, where they have about 2% of the total biologics market, and outcomes depends on a lot of other factors, said one observer.
“Do I think these numbers are reasonable and achievable? Potentially,” said Christina Corridon, MPH, MBA, a principal with the consulting firm ZS, where she heads the firm’s biosimilars practice. She noted that the US market is “not as friendly as it could be.”
However, it is still unknown how may biosimilars will launch in the next few years, she noted, with a lot of “what ifs” that are as yet unanswered.
Sometimes these reports may be construed as a public relations effort to keep encouraging manufacturers to stay in the game, as well as to keep biosimilars in the public eye as a trustworthy cost-savings alternative to name-brand reference products, Corridon said.
There are other details that would be worth knowing, she said, such as, what’s the proportion in these savings in federal spending versus out-of-pocket costs, which can be highly variable? What’s the makeup of the population?
“In some ways I think the [Biosimilars] Forum is giving non-Medicare payers some ideas to wrestle with,” if they really want to help increase competition and lower costs, she noted, since sometimes commercial payers follow whatever CMS decides for Medicare.
There are other questions that have yet to be answered, such as whether payment proposals would look different for a patient who is switched from a reference product versus someone who is naïve to biologics.
“There’s different levels of comfort in switching stable patients,” versus using biosimilars to treat naïve patients, she said.
Additionally, if savings is the goal, some can be achieved without a legislative mandate, depending on how a company outlines the terms of any discounts and through the contracting process, she said.
A Biosimilars Forum board member, Sheila Frame, vice president, Marketing, Market Access and Patient Services at Sandoz, said the proposal lines up with the request for lower pharmaceutical spending from the Trump administration.
“They’re looking for system savings, they’re looking for patient savings, and they’re looking for overall improvement, said Frame. Sandoz, maker of the filgrastim biosimilar Zarxio, remains optimistic about the US biosimilar market, she said.
In addition, increasing patient access and removing financial toxicity through lower costs could help improve patient adherence, Corridon said.
Biosimilars in America: Overcoming Barriers and Maximizing Impact
July 21st 2024Join us as we explore the complexities of the US biosimilars market, discussing legislative influences, payer and provider adoption factors, and strategies to overcome industry challenges with expert insights from Kyle Noonan, PharmD, MS, value & access strategy manager at Cencora.
Hesitancy in MENA Nations to Adopt WHO Biosimilar Guidelines Hinders Market Development
July 17th 2024The World Health Organization’s (WHO) new guidelines for biosimilar approvals aim to save time and money for manufacturers in the Middle East and North Africa (MENA), but hesitancy among nations to adopt the guidelines is stifling market development of biosimilars.
Biosimilars Policy Roundup for April 2024—Podcast Edition
May 5th 2024On this episode of Not So Different, The Center for Biosimilars® glances back at all the major biosimilar policy updates from April, including 2 FDA approvals, 1 European approval, and several insights into possible policy changes from the Festival of Biologics USA conference.