Three Ways Biosimilars Can Play a Role in Value-Based Care

November 9, 2018

As healthcare organizations move toward value-based models of reimbursement, high drug prices can sometimes get in the way of optimal care. Here are three ways that biosimilars may help.

Biologic treatments are at the forefront of biomedical advances in pharmaceuticals-and offer effective relief for a wide swath of medical issues ranging from rheumatoid arthritis to metastatic cancer.  In fact, according to the FDA, biologics are currently the fastest growing segment of therapeutic products in the United States

Yet, due to their complexity, they are enormously expensive to develop and market-and that expense can interfere with value-based models of care.

The passing of the Biologics Price Competition and Innovation Act in 2010 allows pharmaceutical companies to develop and implement biosimilar agents, drugs that are “highly similar” to previously-licensed biologics. Per the FDA, to be considered highly similar, these therapeutics must be comparable to the biologic agent’s purity, chemical identity, and bioactivity.

Kashyap Patel, MD, a physician and advisory board member for the Center for Biosimilars, says harnessing biosimilar agents can help healthcare organizations stretch their limited resources and make the most of value-based care payments and incentives.

“What we see, primarily from their use in Europe, is that the use of biosimilars can be a successful strategy to reduce the overall costs of care,” he says.  “They’ve shown us that they can be incorporated into treatment for many, many diseases-and help healthcare systems manage their costs.”

Here are three ways that biosimilar agents can help healthcare organizations-and their patients-get the most value out of value-based care:

   1. Lowering costs. One of the biggest drivers of biosimilar use is cost. Take cancer care, says Patel. The global costs of oncology and supportive care was estimated to be approximately $100 billion in 2014-and it is only expected to grow.

“The role of biosimilars in value-based care, primarily, is to reduce the cost curve,” he says. “They are less expensive than biologics-so healthcare organizations can better resources to promote a high level of patient care without compromising outcomes due to costs.”

Related: Three Barriers to Biosimilar Adoption

   2. Increasing incentivesCMS not only bases payments on value-based criteria, Patel notes.  It has implemented a second pathway to shift healthcare organizations away from fee-for-service with incentive programs.

“If we can save money overall for CMS, we get some sort of financial reward back,” says Patel.  “That’s money that we can invest in other programs, in more clinicians, or other aspects of care to improve patient outcomes. Having money to spare helps us give back to the practice-and help our patients as a result.”

   3. Improve patient access. But those savings don’t just extend to healthcare organizations.  The use of biosimilar drugs is also a boon for patients.  Patel says that studies suggest that patients save about 18% on out-of-pocket costs when biosimilars are available to them.

“This allows patients to direct what are often limited financial resources to treatments that are safe and effective,” he says.  “It also allows them to consider treatment options that they might not have been available to them or they might not have been able to afford before.  It can make a big difference in outcomes.”

Taken together, Patel says that healthcare organizations can better promote value-based care by adopting the use of biosimilar agents across the spectrum of care. 

“Directly, these therapies can improve access for patients by reducing costs for them. They save healthcare organizations money that can be re-invested back into the practice,” he says.  “Indirectly, biosimilars can reduce overall costs, reduce patient anxiety, and likely improve outcomes. We can balance our resources without compromising the quality level of care-and it’s something that healthcare organizations should be looking at.” 

Kayt Sukel is a science and health writer based outside Houston.