Study: Medicare Advantage Members Are More Likely to Use Biosimilars

Feb 01
Feb 01, 2024

Biosimilar uptake is higher for Medicare Advantage beneficiaries than their traditional Medicare (TM) counterparts, with MA members up to 2.3 times more likely to be prescribed a biosimilar, according to new research published in JAMA Health Forum. The FDA has approved 45 biosimilars so far, with more approvals expected this year.

Researchers from CMS, the FDA and policy research firm Acumen LLC studied claims and encounter data to calculate market share for 20 biosimilars across seven product categories. Biosimilar uptake was higher for MA members in every category but bevacizumab, the generic name for Genentech’s targeted cancer therapy Avastin. Avastin currently has four biosimilars available, with a fifth approved last month.

Researchers noted that bevacizumab can be used off-label to treat age-related macular degeneration, and further stratified the data by ophthalmic vs oncologic usage. While ophthalmic biosimilar use was “very low,” biosimilar uptake for bevacizumab’s cancer indications was 1.1 times greater in MA than TM, similar to the other categories. “This suggests the apparent greater biosimilar use in TM when aggregated across indications is due to the differential dilution of market share by the large overall proportion of ophthalmic usage,” the authors wrote.

Biosimilar use is likely higher in MA vs. TM because MA payment practices and utilization management tools like preauthorization encourage the use of lower-cost products, researchers noted. Further research could account for any population differences between the two groups that might also drive differences in uptake.

“Current estimates of biosimilar savings are greater than $20 billion, meaning each percent increase in overall biosimilar uptake could represent hundreds of millions of dollars,” the study authors concluded. “It is important to validate the increased biosimilar uptake observed in MA and investigate potential mechanisms through which managed care may encourage greater biosimilar use.”

This infographic was reprinted from AIS Health’s biweekly publication Radar on Medicare Advantage.
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Carina Belles

Carina has been covering public-sector health care since 2018. As a data reporter for Radar on Medicare Advantage, she creates infographics and data stories on issues impacting Medicare, Medicaid and Part D. She also develops AIS Health Daily, a free daily newsletter that showcases AIS’s strong reporting across our four publications and parent company Norstella’s suite of market access and data solutions. Prior to joining the editorial team, she managed Medicare and Medicaid data for the Directory of Health Plans, AIS’s industry-standard health coverage database. She graduated from Ohio University with a B.S. in Journalism.