Incentives promoting use of biosimilar medicines in France

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During the presentation at BIOS 22, speaker Nadia Amer described the key figures of biosimilar medicines in France [1], and addressed the incentive measures promoting the use of biosimilar drugs, which have been implemented in France, mostly since 2018 [2].

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The uptake of biosimilars does vary between different countries in Europe. Therefore, targets and incentives have been used across Europe in order to encourage the use of biosimilars [3].

The main incentives targeted to hospital prescribers, prescribers of community-based practitioners and pharmacists are described below.

Incentives to hospital prescribers
1. The payment for performance programme (CAQES, 2019). This programme aims at improving quality and efficiency care, not only medicines where hospitals are awarded bonuses according to score based on several indicators including biosimilar prescription rates with quite a broad scope of biosimilars covering erythropoietin (EPO), anti-tumour necrosis factor-alpha (TNF-α) (etanercept, adalimumab), insulin glargine and granulocyte colony stimulating-factor (G-CSF):

2. Hospital prescribers can also subscribe to one of the following gainsharing programmes:
2.1 The main programme (2018) is where hospital prescribers can get 20% of the difference between the reference drug price and the biosimilar price. It targeted biosimilars with low uptake, such as etanercept, insulin glargine, and later adalimumab was also added to the list.
2.2 There is also an experimentation programme ongoing called article 51 (2018‒2022) where gainsharing of 30% instead of 20% which currently benefits few hospitals but who are selected for the innovative projects in disease management and in care patient pathway. What is specific is that the benefits are supposed to be directly paid to the department or the project holder and not to the whole hospital that they can reinvest the gain in human resources or equipment or training sessions. This programme is currently under assessment, and it may be extended nationwide by the end of 2022. This programme covers biosimilars of etanercept, insulin glargine and adalimumab.

Incentive programmes targeting community-based practitioners
1. The first one is the payment performance model (2016) which included an objective of prescription rate of 40% of biosimilars but only for insulin glargine.
2. More recently, a new programme called Amendment 9 to the medical convention, prescribers can share up to 30% in 2022 and then 20% in 2023 of gains when initiating a treatment with the biosimilars if they are allowed to, or when switching a reference drug with its biosimilar. Five biosimilar molecules are in the scope of this programme: etanercept, adalimumab, follitropin alpha, enoxaparin and insulin aspart.

Incentives to pharmacists
This layer of incentives is to be implemented soon with pharmacists being authorized to substitute a prescribed reference drug with its biosimilar and under certain conditions mainly that the prescribers express no position to it and with approval of the patient. So far, two biosimilar molecules are in the scope, filgrastrim and pegfilgrastrim.

The three incentives programmes described above are mainly created to share the benefits of biosimilar savings with patients [3]. In other words, the goal of benefit-sharing programmes is to generate savings that can be shared among the stakeholders involved, and that can be reinvested to increase patients’ access to treatments, improve quality of care and fund innovation [4].

Related articles
Barriers to biosimilar prescribing incentives in Spain

Targets and incentives to encourage use of biosimilars

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References
1. GaBI Online - Generics and Biosimilars Initiative. Key figures of biosimilar medicines in France [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2022 Oct 7]. Available from: www.gabionline.net/reports/key-figures-of-biosimilar-medicines-in-france
2. Biosimilar medicines: changing patient care pathways, changing outcomes. Webinar BIOS 22. 28 April 2022, Thursday. Speaker: Nadia Amer, Health Economics Analyst, Health Product Department, Caisse Nationale d’Assurance Maladie (CNAM), France.
3. GaBI Online - Generics and Biosimilars Initiative. Targets and incentives to encourage use of biosimilars [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2022 Oct 7]. Available from: www.gabionline.net/reports/targets-and-incentives-to-encourage-use-of-biosimilars
4. GaBI Online - Generics and Biosimilars Initiative. Challenges with implementing benefit-sharing programmes for biologicals in Europe [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2022 Oct 7]. Available from: www.gabionline.net/biosimilars/research/challenges-with-implementing-benefit-sharing-programmes-for-biologicals-in-europe

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