The pandemic may leave employers feeling as though they’re too stretched to take a risk on pushing for broader biosimilar incorporation into employees’ treatment plans, but a group of employers in Michigan in a recent report have shared success stories and tips for achieving success with biosimilars.
The Economic Alliance of Michigan (EAM) is a member of the National Alliance of Healthcare Purchaser Coalitions, and as such has worked over a number of years to advance biosimilar use in Michigan. Biosimilars are often significant drivers of savings in a specialty drug environment that is approaching 50% of the pharmacy counter tab, the group said.
Ford Motor is one company in Michigan that stands out for its success with biosimilars, the group explained. The company managed to convert 100% of health maintenance organization utilizers of brand drug Remicade (infliximab) to the biosimilar Inflectra and 88.1% of users in its preferred provider organization, “with no disruption to patients and no negative feedback from its members,” the EAM said.
The transition to biosimilar infliximab, a drug used to control inflammation in patients with arthritis and other autoimmune disorders, began in 2019, and 4 other biosimilar drugs were added to the program, saving Ford $5 million by 2021, the group said.
Among strategies Ford and various payers (Priority, Blue Cross Blue Shield of Michigan) have used to make their biosimilar programs a success are the following:
- Persuade physicians to accept biosimilars and patients will follow. “The doctor-patient relationship is the closest and most trusted in the health care arena, and physicians can heavily and reliably influence patient decision-making.”
- Build physician confidence in biosimilars by supplying analytics and data about these agents. “Share success stories such as those from Europe, where biosimilars have enjoyed wide acceptance.”
- Use conferences, forums, and other presentations to reach physicians with the biosimilar message.
- Provide physicians with cost and efficacy data on biosimilars. “One health plan ranked its drugs in a continuum of pricing and shared comparisons of prescribing across physician colleagues to illustrate the cost difference of prescribing biosimilars.”
- Share frequently asked questions with patients.
The above examples show that persuading physicians that biosimilars should be used has been a key plank in the effort to get these agents into wider play in Michigan.
The EAM notes in its case study report that biosimilars are as safe and efficacious as the drugs they reference and are rigorously evaluated for quality by the FDA before being introduced to market. There are currently 33 biosimilars approved in the United States and 21 of those have been launched. In Europe, though, many more biosimilars are approved and in circulation. This is largely because the European Union approved its first biosimilar almost 10 years before the United States did (2006 vs 2015).
Biosimilars cost a fraction of what it costs to develop originator products, which is why biosimilars can help save money. “A report from Xcenda shows that biosimilar competition has successfully lowered the price of brand name biologics by an average of 56%,” the EAM said.
Although payers are often seen at odds with employers’ health care goals because of their rebate deals with manufacturers and pricing arrangements that often lack transparency, the EAM reported that manufacturers in Michigan have had some success in collaborating with payers on biosimilar use.
Blue Cross Blue Shield of Michigan and Priority Health have emphasized the use of biosimilars in employer health plans and, via the EAM report, noted the following:
- Biosimilar drug competition with reference drugs is lowering prices of medicine overall.
- Patients have been switching to biosimilars because they are in accord with the goal of reducing costs.
- Biosimilar adoption has been highest in oncology, which is logical because most US biosimilars are for oncology treatment.
- Health plans have been making sure copay assistance for biosimilars is available from manufacturers.
Health plans have managed to incentivize use of biosimilars by eliminating prior authorization requirements for biosimilars while maintaining it on reference drugs, the EAM said. “Removing the administrative burden for biosimilars made the transition easier for physicians and increased uptake.”
Priority and BCBSM pursued a lowest net cost strategy when it came to the choice of drugs for formulary, and this meant considering not just biosimilars but also drug wholesale costs, rebates, discounts, coupons, and other factors. Even so, one health plan managed to achieve savings not by focusing exclusively on manufacturer rebates for use of certain drug products, but by “focusing on the big picture to realize even greater savings through uptake in biosimilars,” the EAM said.
Allowing speciality drugs to be administered outside the hospital setting, which is generally more costly than homes or infusion centers, also enabled savings from biosimilars, the group said.
“Employers indicate this policy was received very favorably by members and one health plan indicated they have achieved savings in the millions of dollars from their ‘site of service’ plan,” the EAM reported.
Ford Motor recommended that considerations be made for employees to cushion the transition to biosimilars. These include:
- Grandfather use of originator drugs in some cases up to 6 months.
- Allow switching to biosimilars when patient treatments are renewed.
- Allow case-by-case reviews in the event there is a problem and patients have special circumstances.
Some employers don’t have the resources to focus on biosimilar transition programs, especially given the pressures imposed by the COVID-19 pandemic. The EAM also noted that employers are often in the dark about what rebates or financial incentives are shared between payers and manufacturers. “In some cases, a pharmacy benefit manager and pharmacies are owned by the same firm,” and “often PBMs’ best interests do not match employers’ best interests.”
Further, COVID-19 has caused worker shortages and led to employees delaying essential health care. “Employers explained that employees missed physicals and other physician visits during the pandemic, and age-appropriate preventive care was delayed or neglected. This interruption in care will create a massive increase of health care needs and will impact the system for years to come,” the EAM report said.
“COVID-19 disruptions have left employers feeling more stretched and risk averse than usual, and therefore biosimilar adoption may not be an area they can prioritize,” it said.
Return to The Center for Biosimilars next week for an interview with Bret Jackson, president of the EAM.