Employers Identify Key Biosimilar Strategies, Knowledge Gaps

By shifting plan design, formulary design, drug pricing, drug availability, and sites of care and drug administration,  employers can create a health plan that is more accommodating for biosimilars and, as a result, may be able to lower healthcare spending, according to a report from the National Alliance of Healthcare Purchaser Coalitions (National Alliance).

With drug prices skyrocketing, employers are looking at all of the tools they can use to keep their own healthcare expenses low and cut costs for employees—tools such as biosimilars. 

“A biosimilar is a copy of a biologic medicine that is similar, but not identical to, the original medicine,” the National Alliance report explained.

National Alliance brought together over 60 employers through seven business coalitions to discuss employer strategies around biosimilars. The Biosimilars Forum funded the effort.

“The US lags Europe in embracing and expanding the biosimilars market,” Michael Thompson, president and chief executive officer of National Alliance, said in the press release. “Educating plan sponsors about barriers to broader adoption of biosimilars will enable them to challenge the market dynamics blocking this critical channel to achieve a more competitive drug market.”

The employer participants highlighted seven biosimilar-related priorities for employers to pursue over the next two years.

First, information about biosimilars can be complicated and contradictory. Education is key to employers using biosimilars effectively as part of their cost-cutting strategies. While insurer organizations such as AHIP and ACHP have already stepped up to promote biosimilars, employers may need to catch up on the basics about biosimilars.

Additionally, information about the interchangeability of biosimilars and biologics can be confusing, and the implications of getting it wrong are urgent. Employers need access to a list of biologics and biosimilars that outlines their interchangeability.

Third, employers need to modify their tactics around prescription drug management. This could take various forms, such as custom formulary design, including biosimilars on newly-launched formularies, and limiting the options for drug infusion sites of care.

Drug rebates can impact costs and spending, so employers must be well-informed about this piece of the puzzle. Employers are looking for tools such as playbooks to help them understand how to discuss drug rebates with other stakeholders.

Current policies also have a role in drug pricing, and employers can have a hand in shaping legislation to bolster their biosimilar and biologic strategies. To do so, however, employers will need to be more informed about how policymaking impacts benefits and drug pricing for biosimilars and biologics.

Employing biosimilars and biologics to reduce healthcare spending requires a strong understanding of precision medicine and its role in population health. Employers need to improve their knowledge and their population health models in this area to accommodate more biosimilar and biologic usage.

Finally, despite these efforts, employers recognize that there is no silver bullet for high drug pricing. They will need to sharpen their strategies around outcomes-based contracting and specialty carve-outs to soften the blow of rising prescription drug spending.

After identifying these priorities, 23 employers completed a post-roundtable survey and offered insight into what strategies they may pursue to achieve these ends. 

Half of the respondents stated that they might use a phased approach to tackle rebates and half indicated that they are considering a tiered site-of-care policy. 

Nearly four out of ten employers who responded to the survey state that they might require full pass-through contracts (38 percent), and slightly fewer employers indicated that they might use full case management for high-cost claims (36 percent). Around a third of the employers are considering custom formulary design, and three in ten are thinking about limited site-of-care options for drug infusions.

“Biosimilars are critical to lowering the cost of drugs in the US, and these findings make it crystal clear that policymakers can achieve billions in healthcare savings by increasing biosimilar adoption and access,” said Juliana Reed, executive director of the Biosimilars Forum. “We call on President Biden and Congress to do more to advance biosimilars to lower drug costs in this country.”