Because they will see greater savings, employers have greater incentive to embrace biosimilars than plan sponsors in the overall insured population. Employers can be advocates for policy changes that promote biosimilars by contacting legislators; they can organize email campaigns to reach lawmakers more easily.
Employers must learn about and advocate for biosimilar uptake in the United States to generate large savings and ensure employee access to affordable prescriptions, according to Matt Harman, PharmD, MPH, senior director of Pharmacy at Employers Health.
“There's a large interest in biosimilars for employers, because when you look at [what] employers spend, about 40% to 50% of costs are on specialty medications,” he said. “That's why we think of biosimilars as maybe the saviors of specialties, since they can really help reduce the cost to those employers.”
Employers Health works to secure health benefits for 400 organizations across the country. Harman helps to oversee pharmacy plan performance of the Employers Health $1 billion pharmacy benefit management group purchasing programs with CVS and OptumRx.
Employers have greater incentive to embrace biosimilars than plan sponsors in the overall insured population, because they will see greater savings. Employers can be advocates for policy changes that promote biosimilars by contacting legislators; they can organize email campaigns to reach lawmakers more easily.
Harman said, “I think that would be a good initiative for employers, because they're anxious and they want to continue to provide benefits to their employees without the rise in specialties spending getting in the way.”
Interest in biosimilars is expected to increase, as more as new insulin products will now be approved under the biologics regulatory pathway, which took effect March 23, 2020, under the Biologics Price Competition Innovation Act (BPCIA) of 2009. This is expected to lower out-of-pocket costs and create a robust, competitive market for insulin products.
“We really need these types of products to create competition to reduce the specialty trends that have been going up and up and up each year,” Harman said.
Ensuring employee access to biosimilars can be complicated as most biosimilar specialty medications, especially for rheumatoid arthritis (RA) and oncology, tend to be on the medical benefits side, which requires more preparatory work in terms of ensuring that cost share is either lower or non-existent.
“A lot of times I think, maybe that trying to ensure cost sharing for those members is the same as it would be the pharmacy benefit and we want to make sure that patients still have access and not where the cost is a barrier.”
Harman also discussed how switching a patient to a biosimilar can be challenging, as patients may not understand what a biosimilar is or if it will have the same effect as the branded reference product they already using. This could be because most biosimilars are administered intravenously.
Harman said that acceptance really depends on physician confidence in biosimilars. “As long as the physicians are on board" and ensuring that clinical outcomes will be the same, "I think patients will be on board and not just being told to switch [without] knowing what could happen.”
He explained that patients with cancer may be less likely to accept biosimilars than those treated for RA, because patients with cancer are more likely to be grandfathered into using reference products, whereas patients with RA tend to change therapies every couple of years anyway.
Policy changes for interchangeability designations would be very beneficial to employers as it would make it easier for employees to have access to biosimilar products if reference products can be switched out at the pharmacy level.
Of employers, Harman said, “I don't think they understand the switching studies and all the different things that are involved, but I know that they're eager to get more medications, or any biosimilars approved with the ‘interchangeable with’ designations to make that adoption rate much easier.”
Policies also need to be passed to ensure physicians have incentives to prescribe biosimilars rather than the more expensive alternatives.
The Prescription Drug Pricing Reduction Act of 2019 would increase the [average sales price] reimbursement percentage from 6% to 8% and "would be a great win for the biosimilar movement to get those products more utilized, and anything to increase interchangeability is really essential,” Harman explained.
He also elaborated on how the term “biosimilar” can be a bit misleading even though those products are as clinically safe and effective as their originators. Misinformation about biosimilars can be a big barrier to uptake and is not surprising, considering the high revenues generated from reference products.
“I get why there's misinformation,” he said. Manfacturers of the reference products must answer to investors, “but we do have to keep fighting the good fight and help speak truth to misinformation, and eventually the truth will overcome.”