Biosimilar Uptake Could Cut Specialty Pharmacy Costs

In order for biosimilars to relieve the impact of high cost specialty pharmacy drugs, more uptake and education is need for patients, providers, and payers, according to a presentation at the National Association of Specialty Pharmacy Annual Meeting & Expo 2017.

“As we know specialty pharmacy is the largest area of cost growth among the prescription drug marketplace,” Richard Brook, president of Better Health Worldwide, Inc, and coauthor of the study, told First Report Managed Care. “It only makes up about 2% of the prescriptions, but increasing to an expected 40% of the money in the next 5 years. One area where we expect to see potential savings is in the area of biosimilars.” 

The researchers surveyed 459 medical and pharmacy directors in the United States on expected biosimilar coverage and impact, then compared the results to surveys fom previous years.

The researchers found that expanded biosimilar use is expected for all reference product indications—with 31% of payers restricting coverage to approved conditions. 

They also found that payers plan to educate providers and patients using different copays for biosimilar products, prescriber and patient mailers, and calls to prescribers and patients. Through additional uptake and education efforts payers forecasted a 20% savings by 2025.

“Until recently, biosimilar savings have been delayed,” Mr Brook explained. “Most United States plans do not expect to realize large savings from biosimilars until multiple products are available for the reference product. In addition, because they are new to the US marketplace, resistance is expected and the plans hope to manage this resistance by educating the prescribers and the patients via phone, mailings, and copay differentials. Most savings aren’t expected until multiple biosimilars are available for the same reference product.”

In his presentation, Mr Brook concluded that “the switch from the medical to the pharmacy benefit for oral biologics and self-injected agents represents a significant change as specialty pharmacy management has grown. Biosimilars are expected to provide some cost growth relief over time and to require patient and prescriber education.”

—David Costill