Biosimilars Popular Among Health Plans

Results from a new survey conducted by Avalere indicate that a majority of health plans are in favor of biosimilars. In fact, the investigators found that 81% of health plans surveyed decided to cover at least 1 biosimilar, according to a press release.

Of the payers who cover biosimilars, nearly all indicated that cost savings played a major role in deciding to cover the drug. Additionally, payers reported that biosimilars are safe and effective, which contributed to formulary decisions.

In 2010, the FDA created a biosimilar approval pathway that was expected to cause an uptick in competition among biologic drugs. The emergence of less costly biosimilars was also expected to result in significant savings for the healthcare system.

Since 2010, the FDA has approved 5 biosimilars, but only 2 have been launched—filgrastim-sndz (Zarxio) and infliximab-dyyb (Inflectra)—which are indicated to treat the same conditions as their reference products.

Avalere also examined how insurance plans cover filgrastim-sndz and infliximab-dyyb to determine if these treatments have the ability to reduce drug spending.

Only 2 years after it was launched by Sandoz, filgrastim-sndz is covered by 94% of employer-sponsored plans.

Additionally, more than 40% of employer plans cover filgrastim-sndz as a preferred drug, according to the study. Placement in the preferred brand tier results in lower out-of-pocket costs compared with drugs on a non-preferred or specialty tier.

“Payers are placing Zarxio in preferred brand tiers, which suggests they are increasingly comfortable with biosimilars once they become familiar with them,” said Gillian Woollett, senior vice president at Avalere. “It also suggests uptake of biosimilars by payers may not depend on biosimilars receiving interchangeability status from FDA.”

Analysis of the formularies revealed that the market for infliximab-dyyb is still being developed, with only 42% of payers covering the drug after 7 months, according to Avalere.

Interestingly, infliximab-dyyb is largely covered in the non-preferred brand and specialty tiers thus far, despite filgrastim-sndz being covered as a preferred brand.

As of February 2017, 64 programs were enrolled in the Biosimilar Products Development Program. The FDA has received requests to discuss biosimilars for 23 different reference products, according to Avalere.