With specialty drug costs commanding an ever-larger share of the total pharmacy spend, the pharmacy benefit manager Cigna is unrolling a shared savings program that, among its signature features, offers patients a $500 health services/products gift card for switching to a biosimilar.
The Shared Savings Program serves as down payment on the future promise of biosimilars. At a time when many people are having to make difficult decisions related to how to afford their medications, this program will offer some direct financial relief and position customers and their employers to recognize greater long-term cost savings.
The plan is expected to be rolled out in July 2021 with more information presented to patients, but in announcing the program, Cigna Chief Clinical Officer Steve Miller stated that a chief goal is to reduce current spending on the infliximab originator product Remicade, which he said costs $30,000 yearly for an average regimen of infusions, “but may be much higher depending on site of administration.”
“While life-saving and life-changing, this [medicine] presents a significant challenge for health plans and can be financially devastating for patients,” he said.
Also, Cigna will move 2 infliximab biosimilars, Avsola and Inflectra, up to preferred status on formulary to get patients and health care providers to use them.
Infliximab is used in the treatment of rheumatoid arthritis and other types of autoimmune diseases. Infliximab biosimilars have seen slow uptake compared with other biosimilars. Clinical investigators have speculated that physicians are more reluctant to switch patients to a biosimilar form of infliximab once hard-to-manage chronic autoimmune conditions are brought under control with the reference product.
Infliximab Market Share Data
After 3 years on the market, infliximab biosimilars had achieved just 20% of the total market for infliximab, according to a 2020 report from Amgen. However, steep declines were noted in average sales price (ASP) for the reference product and the biosimilars available at that time, indicating that biosimilar competitive pressure had succeeded in lowering overall costs of infliximab.
By the second quarter of 2020, Remicade’s ASP had dropped 33%, and the 2 biosimilars on the market at that time, Inflectra and Renflexis, had seen ASP price drops of 43% and 40%, respectively. In July 2020, Amgen launched the infliximab biosimilar Avsola. The respective ASPs at the time for Remicade, Inflectra, Renflexis, and Avsola were $483, $471, $486, and $500.
Manufacturer deals and rebates can cloud the picture of how much is actually paid for biosimilars vs originator products, and Cigna did not provide actual figures on how much it expects to save.
The competitive pricing pressure from biosimilars has the potential to reduce drug spending by at least $225 billion by 2031, Miller said, citing an Evernorth analysis of drug price data that factored in not just the 20 biosimilars already on the market but also biosimilars that may arrive based on pending patent expirations for some key biologic originator products.
To qualify for the $500 debit card, patients enrolled in Cigna plans would have to switch to a biosimilar or another preferred medication.
“The shared savings program serves as a down payment on the future promise of biosimilars. At a time when many people are having to make difficult decisions related to how to afford their medications, this program will offer some direct financial relief and position customers and their employers to recognize greater long-term cost savings,” Miller said.