Will biosimilar provide a ‘magic bullet’ to drug prices in the US? Payers speak out…
Biosimilars continue to be big business in the US, but has progress has been too slow? Not so, argue payers. While the number of biosimilar approvals in the US still lags behind Europe, a solid foundation continues to be laid by multiple key stakeholder groups. Successes have been seen in key areas, including the approval of the first monoclonal antibody (mAb) biosimilar, Inflectra, and regulatory refinement. But what of the critical opportunities and challenges in the US? How do payers perceive what’s important, and what can companies do to ensure commercial success?
Ten expert US payers from government and commercial backgrounds, and all with experience with biosimilars, share their views on the evolution of the US biosimilars market and what challenges still remain. Biosimilars: US Payer Perspectives details their insights on the current status of the US biosimilars market and how they see things evolving.
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“Physicians saw that Zarxio was highly similar and not inferior to Neupogen, so they’re happy to use it. Cost then becomes an issue. Does it make sense for a health plan to adopt a product on formulary if the WAC [wholesale acquisition cost] is only slightly below that of the branded originator? In the end, nobody wants to lose money on biosimilars; the price has to be considerably lower versus where we are with a branded originator, otherwise nothing's going to change. There’s lots of work to be done here. If the net/net price difference isn't worth it, then why go from the brand originator to a biosimilar?”
Chief Medical Officer, National Health Plan
“The FDA will need more data to approve a biosimilar as interchangeable. Companies will need to generate switching data, going from the originator to the biosimilar, and back again.”Regional Clinical Manager, National Health Plan
“Huge! Enbrel and Humira are, across many plans, the number one drug by spend. If you combine them, it would be number one in the US, full stop. Humira and Enbrel biosimilars offer a huge opportunity for savings. It'll be interesting to see whether that materialises. It'll take a little bit of time, but it could be huge.”
Consultant, Payer Strategy
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