AMA: U.S. Health Insurance Plans Prefer Brand Biologics Twice as Often as Lower-Cost Biosimilars

New Analysis Reveals Significant Barriers from Insurance Plans Inhibiting Patient Access to Biosimilars and Increasing Costs

WASHINGTON—A new analysis of 17 of the largest commercial health plans published in the Journal of the American Medical Association found that higher-cost, reference biologics are preferred twice as often as lower-cost biosimilars. The study found that only 14% of the U.S. health plans covered biosimilars as preferred, revealing biosimilar coverage differences across health plans that lead to inadequate patient access to lower-cost therapies.

This study only reinforces the fact that there are significant barriers to accessing biosimilars in the U.S.,” said Juliana Reed, President of the Biosimilars Forum. “Biosimilars on average cost 26% less than the reference biologic, and yet health plans are playing a key role in slowing down access to and use of these safe, effective, FDA-approved drugs — forcing patients and taxpayers to pay billions more for treatment over time.

The 17 plans analyzed in the study represent 60% of Americans covered by commercial health plans. This lopsided preference to the higher-cost reference biologic is a significant contributor to the slow adoption of biosimilars in the U.S., while at the same time creating an environment that forces American patients and taxpayers into the higher-cost treatment option.

In a STAT News piece detailing the report’s findings, James Chambers, an associate professor in health economics at Tufts Medical Center and a co-author of the analysis, said, “Candidly, I found the results quite shocking. If health plans don’t prioritize coverage for biosimilars, then utilization will never grow.”

Biosimilars have the potential to save the U.S. healthcare system up to $150 billion over the next ten years. Already Congress has recognized the cost-saving attributes of biosimilars with several bipartisan proposals introduced in the House and Senate. These policies can increase access to and use of biosimilars — providing direct cost savings throughout the health care system. 

To learn more about the cost-saving benefits of biosimilars and/or the bipartisan legislation already introduced contact forum@skdknick.com or visit supportbiosimilars.com.