Many sites of care are already recognizing that biosimilars can provide much-needed cost savings and expanded access to higher-priced oncology products and therapeutics. In fact, some of AmerisourceBergen’s health system customers have already begun planning for greater biosimilar adoption and implementation into care plans. Following the pandemic, there will likely be even more incentive for providers to consider biosimilars as a way to help offset expenses.
Still, the current economic incentives are not enough on their own; there is also a need to update policies to better support provider reimbursement and continue encouraging biosimilar market growth.
Increased Policy Support
In 2021, we also anticipate an increase in legislation that supports the biosimilar category. Several bills related to reimbursement and cost-sharing are already in existence and will encourage provider choice. Providers should have the freedom to do what’s best for their patients; this includes having the option to leverage biosimilars. Legislation can help afford providers this liberty.
One important policy on the horizon is the Increasing Access to Biosimilars Act of 2020. This law would incentivize physicians to switch patients to lower-cost biosimilars by directing the Centers for Medicare & Medicaid Services (CMS) to implement a shared savings model for biosimilar prescriptions. If passed, this “shared savings” payment strategy would offer providers a percentage of any savings realized, therefore encouraging them to turn to biosimilars—when appropriate—to reduce health care spending for a defined patient population.6
It’s also likely that we will see movement on the Prescription Drug Pricing Reduction Act (PDPRA), which has been awaiting Senate review since 2019. The PDPRA includes a policy change that would allow providers to temporarily receive a higher reimbursement rate for biosimilars, increasing the rate from 6% to 8% of the reference product’s average sales price (ASP) for a period of 5 years.7 If this act passes in 2021, it would give prescribers a larger incentive to use biosimilars and help establish a more level playing field, leading to greater biosimilar cost savings.
Lastly, we will monitor Senate Bill 3466, which would directly impact older patients with cancer. If passed, the bill would waive all out-of-pocket expenses for a biosimilar for beneficiaries of Medicare Part B programs. The Biosimilars Forum projects that this bill could save seniors up to $3.3 billion in out-of-pocket costs over the next 10 years.8 These policies are a step in the right direction and demonstrate the legislature’s interest in pursuing biosimilars to lower health care costs and reduce patients’ out-of-pocket expenses.
Ultimately, we experienced great success with biosimilars in cancer care in 2020, but there is more work to be done in 2021. It’s important to increase competition through approval and launches of biosimilars in cancer markets because oncology is one of the most expensive therapeutic categories. Additionally, in 2021, we need to bring policies over the finish line that provide fair reimbursement for biosimilars and remove barriers for providers.
- McGrail S. Cost of Cancer Care Reaches Nearly $150B Nationally. HealthPayer Intelligence. January 15, 2020. Accessed January 6, 2021. https://healthpayerintelligence.com/news/cost-of-cancer-care-reaches-nearly-150b-nationally
- Amgen Biosimilars. 2020 Biosimilar Trends Report. Amgen Biosimilars. September 2020. Accessed January 6, 2021. https://www.amgenbiosimilars.com/-/media/Themes/Amgen/amgenbiosimilars-com/Amgenbiosimilars-com/pdf/USA-CBU-80723-2020-Amgen-Biosimilar-Trends-Report.pdf
- The IQVIA Institute. Biosimilars in the United States 2020–2024. IQVIA. September 29, 2020. Accessed January 6, 2021. https://www.iqvia.com/insights/the-iqvia-institute/reports/biosimilars-in-the-united-states-2020-2024
- ION Solutions. “ION Solutions Physician Practice Data.” 2020.
- Benyon B. “Biosimilars Can Decrease Costs: But by How Much?” Oncology Nursing News. January 23, 2020. Accessed January 6, 2021. www.oncnursingnews.com/web-exclusives/biosimilars-can-decrease-costs-but-by-how-much
- Increasing Access to Biosimilars Act of 2020, HR 6179, 116th Cong. § 2020. https://www.congress.gov/bill/116th-congress/house-bill/6179/text
- Prescription Drug Pricing Reduction Act of 2019, S.2543, 116th Cong. § 2019. https://www.congress.gov/bill/116th-congress/senate-bill/2543/text
- Fitzpatrick B. New Bills on Biosimilars Access Are Introduced in Congress. Brian Fitzpatrick. March 19, 2020. Accessed January 6, 2021. fitzpatrick.house.gov/2020/3/new-bills-biosimilars-access-are-introduced-congress