Biosimilars Key to Lowering Healthcare and Prescription Drug Costs, According to Employers
New playbook recommends strategies for employers to provide access to biosimilars and to lower healthcare costs for employees and organizations
The use of FDA-approved, lower-cost biosimilars by employers is a key to lowering their healthcare and prescription drug costs. A recent playbook recommends in-depth specific steps self-insured employers can take to initiate the inclusion of biosimilars in their healthcare strategies.
The Employer Playbook on Biosimilars helps individuals responsible for self-insured benefits at private and public employers navigate the challenges of managing drugs in their benefit plans and structure their pharmacy benefit programs to best address misaligned incentives and/or anti-competitive business practices. The findings help purchasers understand biosimilars and facilitate discussions about formulary design, drug pricing and rebates, drug access and accessibility, and site of care and drug administration.
“We are late in prioritizing biosimilar management,” said Cathy Trinh, MS, senior healthcare analyst, SEIU 775 Benefits Group, and a participant in the biosimilars learning collaboratives. “It’s shocking to learn how much we could have saved in the last few years if biosimilars were used instead of the reference products.”
2023 is a watershed year for biosimilars as at least eight biosimilars for Humira, the world’s best-selling drug that has risen 470% in price since first introduced, will launch.
“The clear takeaway from this playbook is that U.S. employers have a tremendous opportunity to include coverage for more biosimilars in their plans, which will lower their healthcare costs and provide their employees with more access to the treatments they need,” said Juliana M. Reed, executive director of the Biosimilars Forum. “Employers must step up and be proactive in demanding biosimilars are fully available to their employees.”
Recommended drug management strategies for employers include:
- Request broker or pharmacy consultant provide an update on drug pipelines and launches to determine if market releases will impact prescriptions and prices
- Consider adopting a custom formulary design or use a phased in approach, one that is not rebate-driven
- Add biosimilars on formulary once they are launched; require all new biosimilar releases be placed in the generic tier to increase adoption
- Request pharmacy benefit managers (PBMs) share formulary strategy to support overall workforce needs (especially those with limited access or equity challenges)
- Do not be lured into 340B pricing plans; ensure the lowest net cost – without rebates – or consider a phased approach
- When multiple biosimilars are available, offer incentives for the use of all biosimilars in the same drug class over the reference product
- Carve out specialty drugs and/or biosimilars with a specialty PBM or pharmacy if that option provides better outcomes
The National Alliance of Healthcare Purchaser Coalitions led the effort to create the playbook by bringing together three member coalitions (Economic Alliance for Michigan, Florida Alliance for Healthcare Value, and Washington Health Alliance) and eight employer members of different sizes and industries to participate in an eight-month initiative.
Funding for this project was provided by the Biosimilars Forum.
About the Biosimilars Forum
The Biosimilars Forum is a nonprofit organization whose mission is to advance biosimilars in the United States — with the intent of expanding access, availability, and affordability of biological medicines, and improving health care. The Biosimilars Forum will provide evidence-based information to inform and support public policies that encourage awareness, access, and adoption of biosimilars.
About the National Alliance of Healthcare Purchaser Coalitions
The National Alliance of Healthcare Purchaser Coalitions (National Alliance) is the only nonprofit, purchaser-led organization with a national and regional structure dedicated to driving health and healthcare value across the country. Its members represent private and public sector, nonprofit and Taft-Hartley organizations, and more than 45 million Americans, spending over $300 billion annually on healthcare.