Payers and employers
Employers
Biosimilars work best in a competitive environment and payers are excited about the availability of new biosimilar products, according to the US Biosimilars Trend Report 2020. A number of plans are now replacing originators with biosimilars, or designating them as preferred products, which demonstrates payers’ confidence in these new products.

In the US, 49% of the population (over 157.3 million people) are covered by employer-sponsored health insurance. As such, employers have an interest in keeping healthcare costs down and biosimilars offer an opportunity for savings.

Over the last 10 years, employee benefits have become a significant budget line item for employers due to escalating healthcare costs, low interest rates and an ageing workforce. Large companies estimate their healthcare costs to increase by up to 6% in 2020, to US$15,375 per employee. This is above expectations for inflation. Year on year, insurers’ medical costs have increased between 5.5%‒9% since 2011.

Adoption and impact for employers
The report explains that employers must balance their healthcare spend with maintaining profits. Biosimilars offer a good option here and one strategy to lower the burden of healthcare costs is to offer value-based policies. It is noted that a survey found that 30% of employers are incentivizing the use of biosimilars and another 39% plan to look into such strategies in the coming two years. In addition, a 2018 study found that if biosimilars reach a 50% share of a biological, annual cost reductions for employers could reach 8.4%, or up to US$315 million.

The National Alliance of Healthcare Purchaser Coalitions outlines some steps for employers to influence change and create opportunities for employees dealing with diseases. These include:
• Quantifying the biosimilar opportunity by initiating conversations with vendors about fill rates and savings potential
• Reviewing specialty pharmacy benefit design to ensure support of appropriate use and access
• Partnering with vendors to determine the best ways to drive appropriate promotion, adoption and utilization of biosimilars
• Educating employees about the value of biosimilars to enable informed decision-making

Patients
Patient understanding of biosimilars is key to their utilization, to encourage their use, education is of paramount importance.

Patients need to understand:

• What a biosimilar is and information on its safety and efficacy
• The types of clinical trial processes undertaken by a biosimilar. If these are not the same as other US Food and Drug Administration-approved products, is that ok?
• The cost of a biosimilar and the cost relative to other available products
• If there are any patient assistance products for biosimilars to help with cost
• If there is a biosimilar product for the biological they are taking and if it is a good idea to switch

Benefits and considerations
Overall, it is clear that biosimilars offer potential benefits to everyone in the healthcare system. They lead to lower spending as they offer a lower cost treatment option and competition can drive prices of all products down. These savings can go towards spending on new, innovative therapies.

Two factors drive savings from biosimilars use:

• Biosimilar development costs less due to the FDA abbreviated approval pathway. Typically, biosimilars can cost up to US$200 million to develop whereas reference products can cost US$2.6 billion. In theory, this spending difference can lead to cheaper products.
• Biosimilars contribute to competition ‒ with more treatment options available for a disease or condition, manufactures may be incentivized to lower prices due to competition.

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Biosimilars policy considerations in the US