France has experimented with financial incentives to reward the prescribing of biosimilars. These incentive structures include shared savings for centers that acquire medicines at lower costs, as well as biosimilar prescribing targets.
While the United States stands alone in having a legal standard for interchangeable biosimilars, in some other countries, biosimilars are able to be substituted for reference products at the pharmacy level. In France, pharmacy-level substitution of biosimilars for reference products is legally allowed, if not widely implemented, for drugs classified by “similar biological groups,” which include reference products and their biosimilars, if the prescribing physician has not expressly prohibited substitution.
A pharmacist can substitute products in these groups at the initiation of treatment, or for patients who are already treated with a product in the group. Physicians can also switch patients at any time, provided that patients are informed and agree to switch, that appropriate monitoring is provided, and that steps are taken to ensure product traceability.
France has also experimented with financial incentives to reward the prescribing of biosimilars. These incentive structures include shared savings for centers that acquire medicines at lower costs, as well as biosimilar prescribing targets. During this week’s International Society for Pharmacoeconomics and Outcomes Research 2019 meeting being held in Copenhagen, Denmark, researchers from IQVIA reported on how great an impact French policies to promote biosimilars have had on a financial level.1
The authors note that, in 2018, treating biosimilars as interchangeable with reference products was expected to yield a savings of approximately €40 million (approximately USD $44 million). But in the context of biosimilars prescribed in hospitals and delivered in retail pharmacies, incentives to prescribe biosimilars did not yield a significant impact on biosimilar penetration, nor did they result in significant cost savings.
In fact, the objective of increasing biosimilar prescribing by 15% among centers that participated in incentive structures (vs centers that did not participate) was not met. Biosimilar use grew by just 8.5% for anti—tumor necrosis factor therapies and by 7.3% for insulins in 2018 versus 2017.
While those findings may come as a disappointment to French biosimilar stakeholders, a second team of researchers reported that France could achieve its objective of 80% biosimilar market share by 2020 if it keeps up current uptake trends.2
Using retrospective observational data, the researchers analyzed market share evolution for 11 biosimilars and 6 reference products over the years 2007 to 2017. During this period, biosimilar expenditures were €6.5 billion (approximately USD $7.2 billion) for the reference drugs versus €0.7 billion (approximately USD $0.8 billion) for biosimilars.
Biosimilar market share increased from 4% to 19% over the studied period, and while biosimilars of etanercept and insulin glargine represented the smallest share of spending during this period, biosimilar of filgrastim and epoetin had more substantial shares.
If the French market continues its current trend, say the authors, France could be on track to meet its biosimilar goals.
1. Bajard P, Duhamel J, Bourguignon S. The incentive financial framework regarding French hospital prescription of biosimilar medicines when delivered in retail pharmacy—impact analysis of Article 51 experimentation for 2018. Presented at: ISPOR Europe 2019; November 2-6, 2019; Copenhagen, Denmark. Abstract PMU53.
2. Parmentier R, Blein C, Borget I, et al. Economic burden of biosimilar delivery in France—real world analysis from the permanent sample of national health insurance beneficiaries, between 2007 and 2017. Presented at: ISPOR Europe 2019; November 2-6, 2019; Copenhagen, Denmark. Abstract PMU151.