America's Benefit Specialist November 2023

A recent analysis of early commercial-payer coverage of HUMIRA and its biosimilars shows that while most commer cial plans are covering biosimilars, 27% of plans surveyed con tinue to prefer HUMIRA over biosimilars, and no plans prefer a biosimilar over HUMIRA. 9 HOW CAN I BEST ADVOCATE FOR MY CLIENTS WITH BIOSIMILARS? Educate your clients about available biosimilars and begin discussions with them about biosimilars expected to be come available soon . The Biosimilars Council, a division of the Association for Accessible Medicines, which represents biosimilars manufacturers, maintains an updated list of FDA-approved and commercially available biosimilars on its website. 10 Discuss how choosing biosimilars may lead to low er rebate revenue, but also how it offers benefits like lower out-of-pocket costs and pressure on branded biologics to reduce their list prices. Talk to your clients about how biosimilars offer the oppor tunity to reduce patient out-of-pocket costs at the pharmacy while maintaining or reducing overall prescription spending. Studies have shown that patients are open to using biosim ilars when they are educated about the product. 11 The high rates of prescribing of biosimilar versions of insulin glargine also demonstrate acceptance of biosimilars by prescribers and patients alike.4 Out-of-pocket costs are very important to patient adherence, persistence and/or discontinuation of therapy, which can all lead to higher overall healthcare costs in the future. In addition, increased medication adherence lowers indirect costs for employers, like workdays missed, when compared to non-adherent patients. 12 When meeting with PBMs on behalf of your clients, be sure to ask about the PBM’s biosimilar strategy. The PBM may offer formulary designs that balance out-of-pocket costs for patients and net costs for payers, even if overall rebate revenues are reduced. 13

1 U.S. Food and Drug Administration. Biosimilar Basics for Patients. www.fda.gov/drugs/biosimilars/biosimilar-basics-patients 2 As of August 2023. Updated information available: https://biosimilar scouncil.org/resource/fda-approved-biosimilars//biosimilarscouncil. org/resource/fda-approved-biosimilars/ 3 Association for Accessible Medicines. The U.S. Generic and Biosimilars Medicines Savings Report (September 2023). https://accessiblemeds. org/sites/default/files/2023-09/AAM-2023-Generic-Biosimilar-Medi cines-Savings-Report-web.pdf 4 IQVIA Institute. Biosimilars in the United States 2023 – 2027 (January 2023). www.iqvia.com/insights/the-iqvia-institute/reports/biosimi lars-in-the-united-states-2023-2027 5 Endpoints News. Here’s How Pharma Companies Might Remove their Products from Price Negotiation (August 30, 2023) 6 Biosimilars Council. Semglee Launch Tracking (July 2023). https://bi osimilarscouncil.org/wp-content/uploads/2023/07/Biosimilars-Coun cil-Semglee-Launch-Tracking-2023.pdf 7 Forbes. Amgen Adopts a Two-Price Strategy for the U.S.’s First Marketed HUMIRA Referenced Biosimilar Amjevita (February 1, 2023). www.forbes.com/sites/joshuacohen/2023/02/01/am gen-adopts-a-two-price-strategy-for-the-uss-first-marketed-humi ra-referenced-biosimilar-amjevita 8 Coherus Biosciences. Mark Cuban Cost Plus Drugs Company Joins Forces with Coherus to Make YUSIMRY, a HUMIRA Biosimilar Available to Patients (June 1, 2023). https://investors.coherus.com/ news-releases/news-release-details/mark-cuban-cost-plus-drug-com pany-joins-forces-coherus-make 9 LaMountain F., M. Beinfeld and J. Chambers. First Look at U.S. Commercial Health Payers’ Coverage of AMJEVITA Shows HUMIRA Remaining on Top – at Least for Now. Center for the Evaluation of Value and Risk in Health (September 12, 2023). https://cevr.tuftsmed icalcenter.org/news/first-look-at-us-commercial-health-payers-cover age-of-amjevita-shows-humira-remaining-on-top-at-least-for-now 10 Biosimilars Council. FDA Approved Biosimilars. https://biosimilar scouncil.org/resource/fda-approved-biosimilars/ 11 Arthritis Foundation. 2022 Biosimilars Patient Survey Results. 12 Fusco N., et al. Cost-Sharing and Adherence, Clinical Outcomes, Healthcare Utilization and Costs: A Systematic Literature Re view. J Manag Care Spec Pharm, 2023 Jan;29(1):4-16. https://doi. org/10.18553/jmcp.2022.21270 13 NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478300/

Melissa Andel is a health policy and reim bursement consultant in Alexandria, Virginia. The Academy of Managed Care Pharmacy is a professional association leading the way in optimizing medication benefit design and improving access to cost-effective and safe medications. Educational material inde pendently developed by AMCP with funding

Are you interested in learning more about this topic? Check out NABIP’s Compliance Corner webinar archives for a webinar from October 2023 that takes a deeper dive into this issue.

from Amgen, Organon, Sandoz and Teva.

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