Survey: Biosimilars are Gaining Momentum Among Payers


AmerisourceBergen/Xcenda survey finds payers believe biosimilars provide costs savings, and they are expected to continuing contracting with manufacturers.

Managed care organizations are anticipating pharmacy benefit plans to include preferred biosimilars and negotiate rebates/contracts, but legal and regulatory hurdles still exist, finds a survey of 51 payers conducted by AmerisourceBergen/Xcenda. The results were presented at the Academy of Managed Care Pharmacy Nexus 2021 meeting in Denver, Oct. 18-21, 2021.

Tasmina Hydery, Pharm.D.

Tasmina Hydery, Pharm.D.

“About 59% of those we surveyed said they agreed that biosimilars have provided their organization with meaningful savings. We have another 35% of people say they somewhat agree with that statement,” Tasmina Hydery, Pharm.D., assistant director in integrated technology solutions at AmerisouceBergen/Xcenda, said in an interview with FormularyWatch.

But Hydery pointed out that because of rebates on the reference products, the reference product can be less expensive. “Even though the sticker price for a biosimilar looks lower, the reference product actually was lower cost to the plan. You have to look beyond the wholesale acquisition cost and at the net price.”

Jennifer Snow

Jennifer Snow

Payers will continue to contract with specific biosimilars in order to drive down pricing and make them preferred, Jennifer Snow, MPH, vice president, reimbursement policy insights at AmerisourceBergen/Xcenda, said in an interview. “They will also implement utilization management but there will be a difference in where they drive preferences and that will drive the utilization as well,” she said.

There is a lot of momentum with biosimilars, Hydery said. “Based on other research we’ve done, we know there is increased utilization of biosimilars over time. When biosimilars first came to the market in 2015, there wasn’t that much preferencing of the biosimilars to the reference product, but now things are changing. There are health plans that are preferring biosimilars to the reference products, and part of that is because of the contracting and negotiating. When that happens, that’s when we see more utilization.”

Complicating the uptake of biosimilars are the various state laws that allow for interchangeability and substitution, Snow said. “We’re watching the legislative and regulatory environment in Washington to see what’s next and whether it is sustainable. There is a lot of interest in biosimilars in the White House and in Health and Human Services,” she said

But the question is what decisions will be made in terms of policy that could potentially hinder the biosimilar market, making it unsustainable. One example of a policy that could hinder biosimilars is consolidated billing codes.

“Currently the market has worked very well if you follow the ASPs in both the innovator and the biosimilar, you can see it certainly drives prices down,” she said. “But biosimilars are never going to be the ‘Hatch-Waxman’ of savings. We should have always been looking this as a 20% savings. It was never going to be pennies on the dollar.”

To help payers assess state regulation, in March 2021, Xcenda launched a Biosimilars Resource Hub within FormularyDecisions, an online platform supporting a community of more than 2,500 health care decision makers in the United States. It enables an information exchange between life-sciences organizations and health care decision makers.

There is a lot of momentum with biosimilars in the pipeline as well, Hydery said. “There will likely be more than one biosimilar for reference products and that creates for payers and manufacturers to negotiate to drive costs down.”

To date, 32 approvals of biosimilars and 20 launches in the United States. Several biosimilars have been approved over the last few months.

Hydery said a biosimilar to be watched is Semglee, the first biosimilar insulin to improve glycemic control in adults and pediatric patients with type 1 diabetes and in adults with type 2 diabetes. The FDA approved this is July as an interchangeable with its reference product, Sanofi’s Lantus (insulin glargine). Interchangeability is a first for an insulin biosimilar.

More about Semglee’s approval

“Insulin has been a huge focus in conversations about cost and affordability. Semglee will be available by the end of the year. This means that payers and pharmacies have some time to prepare for this launch and how they would operationalize this,” Hydery said.

That is already beginning. Express Scripts just announced it will add Semglee as a preferred therapy on its formulary beginning January 2022. Express Scripts estimates cost savings of $20 million in 2022 by preferring Semglee injection on its National Preferred Formulary, which includes more than 28 million lives.

More about Express Scripts’ coverage of Semglee

Another biosimilar to watch is Cyltezo (adalimumab-adbm), an interchangeable biosimilar of Humira. The FDA approved this biosimilar on Oct. 15, 2021, to treat patients with chronic inflammatory diseases including rheumatoid arthritis, psoriasis and Crohn's disease.

More about Cyltezo approval

“Humira generates a lot of spending because it is approved for several indication and a lot of people have received it, and it is fairly high cost,” Hydery said. “A year and a half from now, the patent will be expiring, and biosimilars will be making their ways on to the market.”

Cyltezo available when its commercial license begins on July 1, 2023. This date was the result of a patent ligation.

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