Biosimilars introduce market competition but will savings follow?

Biologics and their biosimilars

lifechanging for patients & dominating drug spend

lifechanging for patients & dominating drug spend

Sept 21, 2023

At PBIRx, we understand the financial strain that specialty drug costs can pose. That’s why we offer expert guidance and support to help navigate the complex world of biologic medications. This medication category dominates prescription drug spend by the hundreds of billions of dollars and is  at the forefront of research and development. Biologic medications influence disease management across multiple therapeutic areas including autoimmune conditions, cancer, and diabetes; their importance cannot be overstated.

Biologics are complex molecules isolated from natural sources such as living microorganisms, plants, or animal cells as opposed to conventional medications that are derived from synthetic chemicals. PBIRx recognizes the need for management strategies for new-to-market biologics and their biosimilars. While life changing for many patients with chronic conditions, biologics have contributed to a financial burden on providers and patients alike. We work collaboratively with our clients to identify innovative solutions to control spending in this increasingly expensive market.

Biosimilars launch to market

Biosimilars launch to market

Will they drive down drug spend?

Biosimilars introduce market competition and represent the potential for significant savings and increased access to high quality care. Biosimilars are created to be highly similar to their reference product (another biologic that is already FDA approved) with no clinically significant differences in terms of safety, purity, and potency. Biosimilars are made from the same types of sources as the reference drug and provide the same therapeutic benefits with the potential to be more affordable.

Biosimilars have been a newsworthy topic as several have recently launched to market for the blockbuster drug Humira. For most of the decade, Humira has been the most profitable drug in the world. To date, only one of the biosimilars (Cyltezo) has been given the interchangeable designation. This designation allows the pharmacist to switch out the reference product for the biosimilar without specific permission from the prescriber. However, there are substitution laws that vary by state and impact the ease of this process; many states require provider and patient notification of substitution. Other reference biologics such as Stelara, Simponi, and Cimzia will be losing their market exclusivity soon as their respective biosimilars are in the pipeline.

PBM cost concerns

Biosimilar formulary inclusions, rebates, and cost complexities

Pharmacy benefit managers (PBMs) and rebates will play a dynamic role in determining access and affordability of each individual biosimilar as monthly costs and manufacturer assistance vary. Understanding the complexities of PBMs and their contracts is challenging. With years of experience in pharmacy benefit consulting and auditing, PBIRx can help plan sponsors understand the pricing impact of biosimilar formulary inclusion/exclusion and ensure maximum savings. PBMs are choosing to include a limited number of biosimilars on their formularies, and this, along with competitive actions by the origination company, will influence biosimilar penetration at the pharmacy level. With the right consultants, plan sponsors can provide the best outcomes for their members while minimizing plan spend.

PBIRx Intelligence

Partnering with you to manage your pharmacy benefit spend

Biosimilars are becoming more widely adopted in the healthcare industry due to their potential to reduce costs for plan sponsors and members. However, beyond the cost component, there are other considerations when choosing a biosimilar. Patients and providers also need to consider factors such as the delivery device, ease of administration, concentration, citrate free status, and indication approvals.

Looking to the future, biosimilars are poised for rapid expansion. If the U.S. parallels the European market, we can expect to see a decrease in sales of reference products and an increase in the adoption of biosimilars. It is important for stakeholders to stay informed and educated on the evolving biosimilar market to make the best decisions for their organizations and their members.

PBIRx will continue to be at the forefront in providing informed guidance to our valued client partners as they navigate the evolving landscape of biosimilars. Our team of pharmacy experts work at the granular level to identify cost-saving opportunities without compromising patient care. With our support, patients can access the medications they need to manage their conditions, while payers can achieve cost savings. Contact us today to learn more about how we can help you manage your biologic medication costs.