Study Offers Clues About Biosimilar Uptake Drivers, Barriers

With policymakers and industry stakeholders increasingly focused on the cost savings opportunities tied to biosimilars, a new Health Affairs study sheds light on some of the factors that influence uptake of these near-copies of pricey biologic medications.

Among almost 200,000 commercial and Medicare Advantage enrollees who newly initiated one of seven biologic drugs with available biosimilar versions — filgrastim, bevacizumab, epoetin alfa, trastuzumab, pegfilgrastim, infliximab and rituximab — the share of people initiating a biosimilar increased from 1% in 2013 to 34% in 2022. Patients who were younger than 18 years were less likely to initiate a biosimilar than other age groups. Meanwhile, enrollees in commercial high-deductible health plans were more likely to use a biosimilar, compared with those in MA plans.

Biosimilar initiation in physician offices was lower compared with hospital outpatient settings, which might be driven by “different drug pricing programs and reimbursement policies between hospitals and physician offices,” according to the study.

Across the nation, the South and West saw higher biosimilar initiation rates, with Texas reporting the highest biosimilar uptake. Patients in Arkansas, Colorado, Kansas, New Mexico, Oregon, Rhode Island and Washington were more likely to use biosimilars than those in other states between 2013 and 2022.

Using data from Optum’s deidentified Clinformatics Data Mart Database, the researchers found that the association of patient and prescriber characteristics with biosimilar initiation varied among the seven drugs. For instance, younger patients were less likely than those age 65 or older to initiate biosimilars for all drugs except pegfilgrastim, which is used to treat low white blood cells after receiving cancer medications.

As of August 2024, there are 29 FDA-approved biosimilars in the U.S. for the seven biologic drugs mentioned in the study. Most people with commercial or Medicare health plans have coverage for biosimilars and their reference biologics under their medical benefit with utilization management restrictions, according to the latest coverage policy analysis data from MMIT Analytics (MMIT is the parent company of AIS Health).

This article was reprinted from AIS Health’s biweekly publication Radar on Drug Benefits.