At a recent Brookings Institute event, outgoing FDA Commissioner Scott Gottlieb, MD, was circumspect about lagging biosimilar adoption. Even though 17 biosimilar drugs are currently approved, very few of those are on the market—and even fewer are found as preferred drugs on payer formularies. Gottlieb said that too many health plans are too focused on short-term financial losses when it comes to biosimilars, ignoring the long-term costs savings that these agents can bring.
Julie Rubin, PharmD, BCPS, director of clinical services for CompleteRx, a pharmacy management consultancy firm, agrees with Gottlieb’s comments.
“Insurance companies are getting rebates from the different drug companies. If they switch to biosimilars, they would lose those rebates. If they use a competitor product like a biosimilar, they are not going to have the same financial incentives upfront,” she says. “Biosimilars usually offer anywhere from 20-30% reduction in price, which helps the patient. But the insurance companies will not get the rebates they would have gotten previously.”
But, Rubin argues, using that reasoning to ignore the potential of biosimilars is short-sighted. And there are other things that insurance companies could do to encourage the biosimilar market beyond looking at this month’s balance sheet.
Here are three ways insurers could help promote biosimilar adoption:
1. Let go of their fear
Rubin says that many insurers have not fully embraced biosimilar drugs, despite the promise of cost savings because of “fear of the unknown.”
“Biosimilars haven’t been out there that long,” she explains. “Are they truly the same? Are they truly generic? The evidence says they are but it’s taking some time for that data to reach everyone.”
Rubin added the many legal issues surrounding biosimilars also have insurers dragging their feet.
“These patent infringement suits make it difficult for some of these drugs to come to market because the biosimilar companies are afraid they will immediately be sued by the originator manufacturers,” she says. “That’s holding back some insurers. But they need get over these fears and look at the opportunities instead.”
2. List biosimilar products as preferred drugs
Rubin said another way insurance companies could hasten biosimilar adoption is by giving biosimilar agents preferred status. She said that some insurers are starting to make those switches.