Comparing biosimilar adoption: Medicare Advantage versus traditional Medicare

Biosimilares/Investigación | Posted 03/04/2024 post-comment0 Post your comment

Biosimilar products, vital for widening access to essential treatments and reducing healthcare costs, face varied uptake influenced by factors like pricing and healthcare settings. Kozlowski et al.'s study compares adoption rates in Medicare Advantage (MA) and Traditional Medicare (TM), revealing significant differences [1].

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With the FDA's approval of 47 biosimilars by March 2024, biosimilars hold promise for addressing the burden of chronic and life-threatening diseases [2]. 

A recent study by Kozlowski et al. compares biosimilar adoption rates between MA and TM programmes. The objective was clear: to unravel the impact of managed care on the utilization of biosimilars, considering the distinct operational mechanisms and incentives inherent in each system.

Researchers analyzed administrative claims data from May 2015 to September 2022 to evaluate the market share of 20 biosimilar products across seven product types, including infliximab, epoetin alfa, bevacizumab, pegfilgrastim, filgrastim, rituximab, and trastuzumab. Additionally, the authors conducted further investigations into two product types: bevacizumab and epoetin alfa. The findings painted a picture of notable discrepancies in biosimilar adoption between MA and TM, illuminating the potential role of managed care in steering healthcare choices.

Across the majority of product types examined, biosimilar uptake was significantly higher in MA compared to TM. The magnitude of this contrast ranged from 1.1 to 2.3 times higher in MA, indicating a pronounced preference for lower-cost alternatives within managed care environments. While nuances emerged upon stratification by specific indications, with TM showing greater uptake in certain therapeutic areas like ophthalmology, the overarching trend pointed towards a higher utilization of biosimilars in MA.

These findings resonate with existing research highlighting the propensity for managed care settings to embrace cost-effective prescribing practices. However, it's essential to acknowledge the potential influence of population demographics and clinical factors, which may shape these utilization patterns. Further exploration, factoring in covariates and disease-specific nuances, is warranted to fully grasp the drivers behind divergent biosimilar uptake rates.

The implications of these findings are profound. Estimates suggest that maximizing biosimilar adoption could yield savings surpassing US$20 billion, meaning each percent increase in overall biosimilar uptake could represent hundreds of millions of dollars.

In conclusion, this study underscores the pivotal role of managed care in shaping the landscape of biosimilar adoption. By showcasing higher uptake rates in Medicare Advantage compared to Traditional Medicare, it underscores the potential of managed care models to drive cost-effective treatment decisions. However, this is just the beginning of unravelling the complexities surrounding biosimilar utilization. According to the authors, further research is imperative to unravel the intricacies of managed care's influence and unlock the full potential of biosimilars in enhancing healthcare accessibility and affordability. 

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1. Kozlowski S, et al. Biosimilar Uptake in Medicare Advantage vs Traditional Medicare. JAMA Health Forum. 2023 Dec.
2. GaBI Online - Generics and Biosimilars Initiative. GaBI Online - Generics and Biosimilars Initiative. Biosimilars approved in the US []. Mol, Belgium: Pro Pharma Communications International; [cited 2024 Apr 3]. Available from:

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