UnitedHealthcare announced the changes in its May 2019 Bulletin. In its clinical policy and prior authorization updates it stated that for commercial and community plan members its medical drug policy will be updated to include preferred product coverage criteria.

The changes means that for pegfilgrastim preferred product language will be added making it clear that members should use the originator pegfilgrastim Neulasta Onpro and Neulasta vial prior to the use of the pegfilgrastim biosimilars Fulphila and Udenyca. In addition to the preferred product changes to the drug policy, UnitedHealthcare commercial plans will be expanding the current prior authorization requirements on these medications to include use for any diagnosis.

These changes will become effective on 1 July 2019 for UnitedHealthcare commercial plans and on 1 August 2019 for affiliate plans (Mid-Atlantic and River Valley). The insurer does say that it will honour current authorizations until their end date, but that upon authorization renewal, the updated policy will apply. It is also encouraging healthcare providers to start using the preferred products immediately.

Biocon/Mylan’s Fulphila (pegfilgrastim-jmdb) was approved in the US in June 2018 and Udenyca (pegfilgrastim-cbqv) was approved in November 2018 [1].

However, despite the fact that Coherus Biosciences (Coherus) launched Udenyca with a list price 33% lower than Neulasta’s [2], UnitedHealthcare will give preferential treatment to Neulasta. This decision is reportedly because Amgen, which makes Neulasta, offered a bigger rebate than either Coherus’ Udenyca or Biocon/Mylan’ Fulphila.

UnitedHealthcare said that ‘in some instances, like Neulasta, the original biologic product may be the lowest cost option as a result of our ability to drive down pharmaceutical manufacturers’. However, although this kind of arrangement is good for insurers, rebate savings are often not passed on to patients. This is because patients' out-of-pocket costs are often based on drugs' list prices, so some will actually end up paying more because of this arrangement.

The insurer also announced in June 2019 that it would prefer the originator infliximab product Remicade over the biosimilar infliximab products Inflectra and Renflexis.

This is also a big difference from the way things work with traditional generics, where patients have to try and fail on the generic drug first before they can try the brand-name drug. In the case of these biologicals, patients will have to use the more expensive drug first.

These kinds of arrangements, according to Denny Lanfear, Chairman, President and CEO of Coherus, are ‘going to put the biosimilar industry out of business if it goes on’.

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Irish hospitals to get incentives to switch patients to biosimilars 

References
1. GaBI Online - Generics and Biosimilars Initiative. Biosimilars approved in the US [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2019 Jun 14]. Available from: www.gabionline.net/Biosimilars/General/Biosimilars-approved-in-the-US
2. GaBI Online - Generics and Biosimilars Initiative. Biosimilars launched in the US at a significant discount [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2019 Jun 14]. Available from: www.gabionline.net/Biosimilars/News/Biosimilars-launched-in-the-US-at-a-significant-discount

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