PMU61 VARIABLE BIOSIMILAR COVERAGE ACROSS US COMMERCIAL PLANS

Abstract

There are several biosimilar/follow-on biologics available in the US, however the level of coverage by commercial plans, and therefore uptake, has been significantly lower than expected. This research examines their coverage by US commercial healthcare plans. Nine of the largest commercial healthcare plan providers in the US were selected, and their publicly-available coverage of ten biosimilar/follow-on biologics along with the seven reference brands was assessed on 16/01/2019. Biologic copies that underwent approval via the abbreviated biosimilar pathway 351(k) as well as the 505(b)(2) new drug approvals pathway were included. The biosimilar/follow-on biologic with the highest level of commercial plan coverage is Sandoz’s Zarxio® (filgrastim-sndz), with 9/9 plans providing coverage, 6/9 (67%) of which also list Zarxio® as a preferred choice over the originator Neupogen® (preferred by 2/9). In contrast, the Remicade® brand has remained a preferred choice among 4/9 (44%) of plans, with the two available biosimilars Inflectra® and Renflexis® preferred by only 1/9 of the plans each. Interestingly, the two available follow-on insulin products, Admelog® (insulin lispro) and Basaglar® (insulin glargine) are viewed distinctly, with Basaglar® being preferred in 5/9 (56%) of plans compared to the originator Lantus® (4/9, 44%), while Admelog® is preferred by only 1/9 plans, versus 6/9 (67%) for the originator Humalog®. The level of biosimilar/follow-on biologic coverage was variable: some plans preferred to maintain access to the branded biologic despite biosimilar availability, while others were incentivized to switch coverage to a biosimilar. Following biosimilar launch, there are often further price negotiations, confidential discounts, and exclusivity contracts taking place between manufacturers and healthcare providers, which influence and shape formulary access. The distinct experiences of the different insulin follow-on biologics emphasize that this step is critical for their commercial success.