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Biosimilars: US Payer Perspectives

Product Code:
Publication Date:
April 2015
Report (PDF) + Advisory Highlights (PPTX)

Biosimilars: US Payer Perspectives pulls back the curtain on the US biologics market and provides detailed and actionable insights from 12 expert US payers from a range of different organisations, including Pharmacy Benefit Managers, Managed Care Organisations and Integrated Delivery Networks.  In addition, receive an Advisory Highlights management summary which covers key findings from the report.

Spending on biologics is set to reach $100 billion in the US over the next couple of years, and biosimilars are seen as a potential safety valve that can relieve some of the pressure on a healthcare system that is creaking under the weight of declining resources, increasing demands and expensive new product launches.

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Caught in the middle of this are the payers, an important stakeholder group whose voice and insight is critically important in understanding the opportunities, challenges and critical success factors that companies operating in the US biosimilars market need to know and understand.

With the US lagging behind many other developed nations in terms of making biosimilars available to its healthcare system, it’s perhaps ironic that recent events have put opportunities and challenges within the US biosimilars market firmly on the pharma industry’s radar. Five 351(k) submissions have now been made to the FDA, and a biosimilar has been approved – filgrastim-sndz from Sandoz, called Zarxio. Companies are partnering and acquiring assets that will allow them to maximise the opportunities, and investors in biosimilar companies have been cheered by share price surges and forecasts from some leading investment banks claiming that biosimilars in the US are on the cusp of greatness. 

Biosimilars: US Payer Perspectives provides a much needed tonic to perhaps the overly optimistic sentiment that has seeped into the discussions about the US biosimilars opportunity. Critically it provides unique payer insights on some of the critical market shaping issues that are dominating discussions, including pricing, substitution, switching, indication extrapolation, naming and originator company defensive tactics. 

The US market holds many opportunities for biosimilar developers, but in order to leverage these opportunities and maximise chances of success, biosimilar developers and originator companies must read this report to understand what payers really think, and how they will act in response to cheaper biologics becoming available.


Part of the FirstWord Dossier family of reports exploring important trends and challenging issues affecting pharma, FirstWord Dossier Advisory Reports and Highlights provide actionable insights derived from deep-dive primary research with thought leaders from across the stakeholder spectrum through an in-depth report and a management summary of key findings ensuring clients are up to speed and can bring others up to speed quickly.


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Top Takeaways

  • Understand what payers are focused on in their efforts to cut the costs of biologic therapies on their plans, and how they would prefer to make savings in order to limit disruption to their members
  • Identify what payers perceive as the biggest drivers and resistors to biosimilar usage in the US, and how health plan design and payer activities could shape the biosimilars market in the US
  • Learn what payers believe are the critical success factors in the US biosimilars market, including pricing strategies, educational efforts, physician engagement and provision of clinical data
  • Benchmark potential pricing, market share and source of business across five key classes of product, including modern insulin, filgrastim, EPO-alfa, oncology mAbs and non-oncology mAbs

Get Answers to Critical Questions

  • What current strategies for cost-containment in biologic therapy are being used by payers in the US?
  • How do payers expect to manage inclusion of biosimilars on to their formularies, and what critical pieces of information will they need to see before making any decisions?
  • From the payers’ perspective, what are the current levels of awareness, familiarity and acceptance of biosimilars at the payer and physician level, both personally and generally across each stakeholder group?
  • What do payers see as the key drivers and resistors of biosimilar usage in the US?
  • Do payers agree with the current US Food and Drug Administration (FDA) requirements for biosimilars, and what are their expectations for future regulatory refinements?
  • What do US payers see as the most important reimbursement challenges for biosimilars, including insights on rebating and payment models?
  • How do payers expect pricing dynamics within the US biosimilars market to evolve, and what are their expectations in relation to the pricing of originator biologics in response to biosimilar competition?
  • What are the views of US payers in relation to the key market shaping issues of switching, automatic substitution, extrapolation of indications and biosimilar naming?
  • What do US payers see as the critical success factors for the US biosimilars market, both from a biosimilar and originator biologic manufacturer perspective?

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Experts Interviewed

FirstWord interviewed 12 payers and also sought the opinions of a range of commercial, regulatory, legal and clinical experts to deliver contemporary, actionable and robust insight on the US biosimilars market:

  • Pharmacy Director, Health Plan Division; Pharmacy Benefit Manager
  • Chief Medical Officer & Chair of P&T Committee; Regional Health Plan
  • VP, Pharmacy Services; Managed Care Organisation
  • Executive VP, Rx Analytics; Pharmacy Benefit Manager
  • Chief Medical Officer; Integrated Delivery Network
  • VP, Formulary Management; Medicaid Plan
  • National Senior Medical Director; Managed Care Organisation
  • Pharmacy Director; Managed Care Organisation
  • Medical Director; Managed Care Organisation
  • Chief Pharmacy Officer; Pharmacy Benefit Manager
  • Pharmacy Director; Regional Health Plan
  • Pharmacy Director; Managed Care Organisation

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About FirstWord Reports

FirstWord is an innovative industry intelligence leader serving over 240,000 Pharma professionals worldwide. FirstWord offers a range of products and services designed to help your company gain a competitive edge by making key business decisions with speed and confidence.

  • FirstWord Pharma PLUS is a personalised and comprehensive intelligence service delivering up-to-the-minute pharma news, insight, analysis and expert views of importance to your company’s success.
  • FirstWord Reports deliver timely, need-to-know intelligence about your products, your competitors and your markets. Covering biosimilars, market access, medical affairs, sales & marketing, technology and therapy areas, FirstWord Reports provide expert views and intelligence on the challenges facing pharma today.

Learn more at www.firstwordgroup.com.


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