Dr Marcus Snow: 2017 Saw Increased Familiarity With Biosimilars, But Not Increased Uptake

According to Marcus Snow, MD, assistant professor of internal medicine in the division of rheumatology, University of Nebraska Medical Center, some of the most critical developments in the biosimilars space during 2017 were the result of payer decisions.

CMS’ move to assign biosimilars unique reimbursement codes is a “big step,” according to Snow, but he also points to what he calls “a smaller development that signals that biosimilars may take longer than expected to have a market share"—the agreement between UnitedHealthcare and Janssen that resulted in the brand-name Remicade being made the payer’s preferred infliximab therapy. “While [the move] is not unexpected from a business sense, it did signal to all in rheumatology practice that biosimilars in the [United States] may have much slower uptake than many thought. It will be interesting to see how other payers adjust to competition in the biologic marketplace.”

Slow market entry and sluggish market uptake are cause for concern for Snow. “Amjevita (adalimumab-atto) will not be available until 2023 [in the United States] due to a legal settlement. It is FDA-approved, and many hoped it would be available in the near future but, it will not be available here for quite some time,” and even those therapies that have launched have struggled in the marketplace: “Inflectra has only reported about 2% of the market share despite being FDA approved and commercially available…which is maybe a bit surprising, but this demonstrates more of a formulary issue than lack of use or desire to use biosimilar infliximab by the treating rheumatologist.” Snow added that, “While the choice in treatment ideally would come out of a discussion between the treating provider and the patient, the decision regarding drug availability to the patient is made by the [pharmacy benefit manager] and the insurance company, not the healthcare provider.”

In 2018, Snow hopes to see a market entry for the first FDA-approved etanercept biosimilar, Erelzi, which he says “would probably be the most interesting biosimilar,” as it “would be the first available subcutaneous [anti—tumor necrosis factor] biosimilar in the rheumatology world, especially with the delay of Amjevita’s US debut…the availability of both drugs has been delayed due to legal challenges, but Erelzi is reported to be close to becoming available,” said Snow.

As rheumatologists wait for greater biosimilar availability, Snow reports that he sees increasing awareness of biosimilar therapies among his peers: “There is increased familiarity with biosimilars among rheumatologists, and this will keep growing in 2018. When [biosimilars] truly become available to the provider, trust in the biosimilars will grow quickly [as] the provider becomes more familiar with the drug.”