The Association for Accessible Medicines’ report on Medicare Part D tiering revealed low coverage rates for insulin and adalimumab biosimilars across plans.
Despite the US having more biosimilar options than ever before, Medicare Part D plans still prefer reference insulin glargine (Lantus) and adalimumab (Humira) over lower-priced biosimilar alternatives, according to a report from the Association for Accessible Medicines (AAM).
The report looked at results from Avalere’s analysis on understanding the distribution of biosimilars relative to their originators on Medicare Part D formulary tiers for program year (PY) 2023. Avalere synthesized public use files (PUFs) from PY 2024 to assess coverage, tiering, and utilization management of drugs covered under Part D plans, including Medicare Advantage plans, focusing specifically on the insulin glargine, adalimumab, epoetin alfa, pegfilgrastim, and filgrastim markets.
Avalere included over 5500 plans across all 50 states and Washington, DC, and the 5 largest Part D parent organizations in 2023 (United Healthcare, Humana, CVS, Centene, Cigna), regardless of whether they covered any of the studied products.
By parent organization, the researchers looked at:
Results showed that Lantus generally had higher coverage, preferred tiering, and less restrictive utilization management (UM) compared with its biosimilars. While 80% of plans covered branded or unbranded Lantus, less than 10% of plans covered branded or unbranded insulin biosimilars. There were also no differences in coverage for prefilled pens vs prefilled syringes for coverage, tiering, or UM. United Healthcare, CVS, Centene, and Cigna did not cover any insulin biosimilars.
Similarly, immunological agent biosimilars were significantly less likely to be covered by plans compared with their reference products. When covered, immunological agent biosimilars were typically placed on specialty tiers, indicating a higher level of restriction or management compared with reference products.
Humira biosimilars were not covered, and prior authorization was required for Humira, suggesting that plans were more inclined to cover the reference product rather than its biosimilars. UM strategies like prior authorization were commonly applied to control access to Humira. However, CVS, Cigna, and Centene did not cover any adalimumab biosimilars despite 8 products entering the market by the end of July 2023.
Although some biosimilars, such as Cyltezo, were covered by a higher number of plans compared with other Humira biosimilars, overall coverage of Humira biosimilars remained low across all plans, likely because it was the first adalimumab biosimilar to be granted interchangeability status.
Budget Impact Analysis of Biosimilar Natalizumab in the US
Projected savings from biosimilar natalizumab were $452,611 over 3 years, driven by decreased drug acquisition costs and a utilization shift from reference to biosimilar natalizumab.
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.
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.
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.
BioRationality: Time to Get Rid of PBMs if Biosimilars Are to Succeed
July 15th 2024Sarfaraz K. Niazi, PhD, discusses the challenges with pharmacy benefit managers (PBMs) that plague the biosimilar industry and new legislation that attempts to reform their practices and encourage biosimilar adoption.