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Impact of Biosimilars on Payers, Health Care System, and Patients


Roy M. Fleischmann, MD, and Joel M. Gelfand, MD, MSCE, FAAD, discuss the impact of biosimilars on payers, health care systems, and patients.

Roy M. Fleischmann, MD: Let’s get to the real question here. Once a biosimilar is seen to have interchangeable designation, how can it impact or benefit the patient, the provider, and payers? Let’s start off with the payers.

Joel M. Gelfand, MD, MSCE, FAAD: We should expect that there will be some reduction in the cost of these biologics to payers, which in our system in the United States likely won’t be particularly transparent to clinicians or patients. The discount is unlikely to be that substantial. Usually, you’re looking at discounts of around 10%. For products that are already extremely expensive, on the net basis, when you’re looking at thousands of patients being treated, there will hopefully be significant savings to health systems and insurers. But for individual prescriptions, the difference isn’t going to be tremendous.

Roy M. Fleischmann, MD: It’s a complex question because it depends on the health care system. In Norway, when a biosimilar became available, the price of the reference product for that biosimilar dropped 90%. Why was that? Because in Norway, it’s a single-payer system. It’s the government. The government put it out for bid and said, “We’ll pick the cheapest one. Whether I start a patient on a biosimilar or a reference product, you’ve already proven that it works as well as the other for 95% or 98% of the patients, so I’m going to take the cheapest one. What’s the price?” And it dropped 90%. In Europe biosimilars already have great uptake, but the reference products had to lower their prices substantially to do that.

In the United States, we don’t have a single-payer system. We have a health care system, but not really. We have everything. We probably have the best health care system in the world, but it isn’t really a health care system. It’s run by the pharmacy benefit managers [PBMs]. The pharmacy benefit manager may get a substantial price reduction from the biosimilar manufacturer, which may or may not compensate for the rebate, which is the money that the reference product company pays a PBM in order to use their drug. But assuming that the price drops, the payer, the PBM, may pay less, but what’s going to be the benefit to the patient? That’s what you were talking about. In the United States, when you have a biosimilar or even an interchangeable biosimilar, is there a benefit to the patient?

Joel M. Gelfand, MD, MSCE, FAAD: In the field of dermatology, we’re still waiting for biosimilars to be available. The only biosimilar available is for infliximab, which isn’t a drug we commonly use. Hopefully the benefit for the patient and clinicians would be more access, fewer denials, and fewer step edits to get the patient on the biologic we want, assuming that biologic has a biosimilar. That’s what the hope is. We’ll have to see what comes to bear when these biosimilars—particularly subcutaneously administered TNF [tumor necrosis factor] inhibitors—become available, and how it plays out in the real world.

Transcript Edited for Clarity

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