PMS70 - BIOSIMILAR AND ORIGINATOR ETANERCEPT: INFLUENCE OF LOCAL POLICY MEASURES AND PRACTICES ON MARKET DYNAMICS BETWEEN SWEDISH COUNTIES

Abstract

This study aims to analyse market dynamics of originator and biosimilar etanercept in the different counties of Sweden, and examines the influence of local policy measures and practices, in addition to national policy. This study was performed in three steps: (1) a structured review of the literature on (biosimilar) policies in Sweden, (2) analysis of market data on the counties’ originator and biosimilar etanercept uptake (Q2 2012 to Q4 2017) provided by IQVIA, and (3) discussion of findings with a national health authority, key experts in Skåne, Västra Götaland, and Stockholm, and an industry representative. Notwithstanding the existence of a national managed entry agreement for etanercept, wide variations in biosimilar market shares between counties were observed (40% to 82% in 2017). Over time, early and late adopters of biosimilar etanercept can be distinguished. As prescriptions are often provided for a year, two possible approaches to switching patients were observed in counties: active pullback of prescriptions resulting in additional workload, or wait until the patient’s next visit. It can be noticed that switching is generally more driven by hospitals or individual physicians than by the county councils. Except for price differences between originator and biosimilar, the following factors that influence market dynamics differ between counties: presence of KOLs, local guidelines, and gainsharing arrangements. Regional variations in use of biosimilar etanercept can be seen although prices are coordinated nationally. The decision to switch or wait for lower prices is only affected by the county’s policy and attitudes of stakeholders towards biosimilars and switching. It seems that, for etanercept, counties are hesitant to switch patients, as it is associated with an increased administrative workload. Furthermore, a substantial price difference and guarantees that this will not change for a longer period are lacking in the etanercept market.