Survey Shows Payers More Likely to Prefer Multiple Biosimilars for the Same Reference Product

Panelists at the 2023 Asembia Specialty Pharmacy Summit reported that payers are more likely to prefer multiple biosimilars for the same reference product rather than just prefer 1 biosimilar or just the reference product.

The session “Will Biosimilars Be Larger than Life? A Review of Payer Response to Changes in the US Landscape” covered the current biosimilars landscape, how payers view biosimilars at present, how biosimilars are being operationalized, and current pieces of legislation that are affecting biosimilar adoption. Asembia 2023 is being held in Las Vegas, Nevada, from April 30 to May 4.

Tasmina Hydery, PharmD, MBA, BCGP, associate director of digital solutions at AmerisourceBergen, shared data on the payer perspective from her organization. The data were from a survey of 51 payers, and it found that 55% of payers each said that they use manufacturer materials and published literature to monitor the pipeline.

Additionally, when multiple biosimilars for the same reference product were on the market, 45% of respondents said they would pick 2 to 3 to add to their preferred list, while 35% said they’d pick 1 biosimilar and only 4% said they’d only prefer the reference product. Hydery noted that these numbers have changed significantly since biosimilars were first introduced to market.

“If we did this survey about 5 years ago or more, it would have probably been a little bit more bottom heavy, where organizations would more so want to prefer the reference product…. Over the long term, now it looks like there's room for at least 2 or 3 biosimilars to be preferred,” said Hydery.

When looking at which factors will have the biggest impact on adoption, 88% of surveyed payers said interchangeability will be a big factor, followed by real-world evidence (55%), patient support programs (39%), first-to-market (37%), and device features (37%).

Cate Lockhart, PharmD, PhD, executive director of the Biologics and Biosimilars Collective Intelligence Consortium, explained that these results are concerning because interchangeability is a regulatory designation affecting the ease with which pharmacists can dispense biosimilars and is not an indicator of whether a biosimilar is better than another, saying that she feels that the existence of the label is “irritating.”

To obtain interchangeability, in most cases manufacturers must conduct costly and time-consuming switching studies, where patients are switched back and forth between the biosimilar and the reference product several times to determine that switching is safe.

“It's a sort of a conundrum for us in the United States that we have this extra layer that mostly causes confusion, and it causes expense for the manufacturers. But this is a really important piece now in the US marketplace,” Lockhart noted.

Hydery went over factors that may influence a payer's decision to prefer a reference product over its biosimilar competitors, finding that 96% cited lower prices and 82% said contracting agreements.

“We see this happening today, it's not really surprising. If [originator manufacturers] want to stay competitive when a biosimilar comes out, they really need to show why they should be picked…. It's also interesting to see…that physician demand and patient demand have been a factor in a little bit, at least at 18% and 10%, [respectively],” Hydery explained.

Prior authorization (100%) and step edits (76%) were listed as the most common techniques among payers to encourage the use of preferred products, whether they were reference products or biosimilars.

Lockhart touched on the possible impact that the Inflation Reduction Act (IRA) will have on biosimilars, saying that although the increase in Medicare reimbursements for biosimilar will help, the ability for Medicare to negotiate pricing with manufacturers will prioritize originators that do not have biosimilar competition, discouraging companies from pursuing a biosimilar in those spaces.

Under the IRA, Medicare will be able to negotiate 10 Part D drugs in 2026, 15 Part D drugs in 2027, 15 Part B or Part D drugs in 2028, and 20 Part B or D drugs in 2029 and beyond.

“This legislation really has a potentially direct impact on biosimilars. It could be positive, where they're dictating some reimbursement levels for Medicare. But…this negotiation piece has some complexity. And so, we obviously don't know [the overall impact]. But I think there's a lot of speculation and everybody's watching this space very closely because of its impact on biosimilars specifically.”