This study assessed the potential impact of physician-administered biosimilars for the originator products trastuzumab, bevacizumab, and rituximab on patient out-of-pocket cost in the U.S. healthcare system. A retrospective medical claims analysis evaluated claims for patients taking trastuzumab, bevacizumab, and rituximab in 2018 and 2019. Expected patient cost reductions due to biosimilars were modeled using a Markov model based on pricing assumptions for biosimilars and current patient costs for originator products based on payer coverage and type of cost (deductible, coinsurance, co-pay). A total of 24,164 trastuzumab claims, 24,641 bevacizumab claims, and 18,113 rituximab claims in 2018 and 2019 were analyzed. Of the average monthly system cost savings, patients could see 7% of the savings for trastuzumab’s biosimilars ($1,692 average system savings), 8% for bevacizumab’s biosimilars ($1,875), and 9% for rituximab’s biosimilars ($7,697). Patients whose cost sharing is based on coinsurance could see a direct cost reduction due to the lower cost of biosimilars, impacting 13%-17% of all claims, 12%-16% of which are Medicare Fee-for-Service patients without supplemental insurance. Some commercial patients (5%-12%) and Medicare Advantage patients (21%-23%) who face coinsurance could also experience cost savings. While total spend may not change for commercial and Medicare Advantage patients due to U.S. mandated out-of-pocket limits, patient costs could be redistributed across more procedures for 17% to 25% of all claims. Physician-administered biosimilars are driving down the cost of care to the U.S. healthcare system. However, only a portion of patients realize the savings generated by biosimilars, specifically patients who face coinsurance. The U.S. healthcare system limits annual out-of-pocket expenses for commercial and Medicare Advantage patients, eliminating a portion of cost saving realized by patients with high cost healthcare expenses. Without system changes, these dynamics pose a risk to the use of biosimilars in the U.S. market.
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