Biosimilar Basics Part 3: Getting Biosimilars to Market

What Works and What Doesn’t

March 28, 2023
News about biosimilars is everywhere. Sometimes you just need the basics. This four-part series gets you what you need to know.
Part 1: What are biosimilar drugs?
Part 2: Biosimilar naming conventions: Top 10 acronyms to know
Part 3: Getting biosimilars to market–what works and what doesn’t.
Part 4: Biobetters and biosimilars: What’s the difference? 


Nine of the biosimilars launched in the United States are in one drug class, called granulocyte-colony stimulating factor, or G-CSF.

This drug class treats neutropenia, a condition that’s often a side effect from cancer. About 11,000 patients every year take a G-CSF drug, generally for about six months. But because it’s for patients with cancer, that patient pool continuously turns over. There are new patients with neutropenia who need G-CSF, every month, every year.¹

Those G-CSF biosimilars are priced 10 to 30 percent lower than the reference biologics. The FDA review affirms there’s no clinically significant difference between a biosimilar and its reference biologic.²

One would then expect that health plans and payers would convert quickly to the biosimilars, right? To save money while delivering the same health outcomes? Those expectations would be wrong. The availability of biosimilars, on its own, does not move the market.

MedDrive™ helps deliver significant savings for Blue Plans that prefer biosimilars

Prime Therapeutics’ MedDrive™ program leverages biosimilars to cut member drug expenses by 26% in one year.3 This integrated drug management solution leverages biosimilars to help reduce drug spend.

MedDrive™ has already helped Prime’s clients realize savings by improving manufacturer contracts and recommending the use of biosimilars and other low-cost alternatives to expensive brand-name specialty drugs in the market.

Prime reported that its MedDrive program achieved significant savings in its first year, with biosimilars for treating cancer leading the way. The program, originally launched in May 2021, uses advanced analytics to help health plans uncover opportunities to reduce current drug spend.

Drug prices continue to rise, which puts pressure both on insurers and the members they serve. MedDrive leverages the collective strengths of Blue Plans and Prime to put the brakes on medical drug spend without compromising patient care.

Within the MedDrive program, just three biosimilar categories (including G-CSF) have helped cut total drug expenses by 26% over the past year, with more savings anticipated in the next year.1

In addition to identifying cost savings through biosimilar use when applicable, MedDrive leverages advanced analytics and proactive consulting to understand what factors are driving a client’s medical drug spend and pinpoint specific changes that can surface savings.

In the 90s, many consumers resisted switching to generic drugs

The FDA, health plans, employers and PBMs — everyone in the health care system — pitched in with education campaigns. The goal was to make sure consumers were being informed that generic drugs deliver the same quality as brand-name drugs.

In some ways, we face the same consumer resistance with biosimilars today. Except now, instead of switching to generics for treating their high cholesterol or high blood pressure, consumers are being asked to  to switch to biosimilars for treating their cancer. It’s a bigger decision.

We work closely with our Blue Plan clients to support benefit design decisions that help improve care and control costs. Prime has a customer experience team experienced with journey mapping. This gives us insights into when patients are looking for treatment information and are open to receiving it.2

Missing facts and misinformation about biosimilars and the biosimilar market have made many health plans and employers hesitant. And that’s costing them money.4 It’s important to get the facts out there.

We’re not only educating about biosimilars, but we’re re-educating to counter the misinformation. This statement is from the FDA and FTC’s announcement to support a more competitive market for biological products.

"Making false or misleading statements about biosimilars may slow progress and hamper uptake."The FDA has issued guidance5,6  to help clarify questions around submissions for ABLA and language around labeling and marketing. It’s putting on workshops.7 And it’s pursuing bad actors. But like the news right now – we are all responsible for checking our sources and getting good information.

Continuing education opportunities on biosimilars will improve physicians’ and pharmacists’ ability to provide appropriate information to help patients make informed care decisions that include biosimilars.7

The biosimilar will not be automatically substituted for the biologic. The doctor will need to prescribe the biosimilar. Benefit design elements can come into play, like preferred drugs, reimbursement contracts with providers and more. Prime has a toolbox of programs it puts to work on behalf of members and payers – but always with the goal of improving health outcomes and lowering cost of care.

What’s next?

Learn more about how biosimilars help lower drug costs while maintaining patient care by visiting our Biosimilars page.

Want to talk about how adding them to your plan could benefit both you and your members? Contact us directly.


References

  1. Prime Therapeutics launches MedDrive™, a first-of-its kind medical drug management program uniquely aligned with its Blue Plan clients. Prime Therapeutics newsroom. Accessed at: https://www.primetherapeutics.com/news/prime-therapeutics-launches-meddrivetm-a-first-of-its-kind-medical-drug-management-program-uniquely-aligned-with-its-blue-plan-clients/
  2. Prime Customer Experience Group
  3. Prime Therapeutics’ MedDrive™ program leverages biosimilars to cut member drug expenses by 26% in one year. ©Prime Therapeutics. Accessed at: https://www.primetherapeutics.com/news/prime-therapeutics-meddrive-program-leverages-biosimilars-to-cut-member-drug-expenses-by-26-in-one-year/
  4. Large employers could have saved money if more biosimilars had been prescribed, By ED SILVERMAN, April 2, 2020. STAT NEWS. Accessed at: https://www.statnews.com/pharmalot/2020/04/02/biosimilars-biologics-drug-prices-
  5. The FDA and FTC Announce New Efforts to Further Deter Anti-Competitive Business Practices, Support Competitive Market for Biological Products to Help Americans. Feb 2, 2020. FDA.gov. Accessed at: https://www.fda.gov/news-events/press-announcements/fda-and-ftc-announce-new-efforts-further-deter-anti-competitive-business-practices-support
  6. Draft guidance: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/biosimilars-and-interchangeable-biosimilars-licensure-fewer-all-conditions-use-which-reference
  7. Webinar: https://www.fda.gov/drugs/news-events-human-drugs/public-workshop-fdaftc-workshop-competitive-marketplace-biosimilars-03092020-03092020

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