Alex Brill, CEO of Washington, D.C.-based economic policy consulting firm Matrix Global Advisors (MGA), recently published a strategic proposal suggesting how payors can support biosimilar utilization.
Biosimilars are less expensive copies of biologics and are just beginning to enter the U.S. market.
“Because biosimilar utilization can be significantly facilitated by physicians, the full potential of biosimilars in the United States will be realized more quickly if doctors embrace their use,” Brill wrote. “In light of this, a carefully constructed physician incentive from public and private payors could boost biosimilar utilization significantly, benefitting patients and the health care system as a whole.”
Brill explained that biologics are currently among the most expensive drugs available, and represent a large and increasing share of U.S. drug spending. Unfortunately, a “robust” biosimilars industry that yields maximum benefit for patients is currently far from certain.
“To date, utilization of biosimilars has been hampered by the simple lack of approvals,” Brill recently told American Pharmacy News. “A slow start on regulatory implementation by the FDA along with some initial hesitation by manufacturers means only two products have been approved. Looking forward, I expect the pace will pick up some but not a lot.”
Brill pointed out that physicians do not currently expose biosimilars to their patients because they do not have any incentive to do so.
“Public and private health care payors have long employed coverage and reimbursement strategies geared toward patients and providers in pursuit of containing costs and improving health care outcomes,” Brill said. “In some areas of health care that are less patient-driven, beneficiary cost may be disconnected from treatment decisions because patients’ financial concerns are not foremost in physicians’ minds when discussing treatment options with patients. Biosimilar utilization will likely fall into this category.”
Brill argued that to overcome this disconnect, policymakers and payors should encourage better alignment between patients’ financial concerns and physicians’ approach to presenting treatment options. This would keep with recent payment reforms that reward providers who meet outcome metrics that improve quality and save money.
“There will certainly need to be an adequate education campaign to assure providers and patients of the benefits of biosimilars,” Brill said. “That's the case with any new product and as biosimilars first enter the market, extra efforts will be required.”
Brill explained how providers will likely approach biosimilars as they are introduced, which involves a lot of caution.
“Many providers may take a wait-and-see approach because of the newness of this market,” Brill said. “Manufacturers will need to educate and payors will need to encourage their utilization as well.”
Brill also noted that there are ways to create incentives to use biosimilars.
“It is all the more important to implement policies to encourage biosimilar utilization,” Brill said. “Policymakers and payors could, in a manner similar to how some payors promote increased generic utilization, encourage physicians to use biosimilars by rewarding them for doing so.”
Despite its growing popularity and possible incentives to use biosimilars, attention also needs to be paid to its legal and ethical implications.
“It would, of course, be necessary to construct biosimilar utilization incentives to ensure that they serve their intended purpose,” Brill said. “In addition, the legal and ethical implications of incentives would need to be carefully considered. But, considering the cost savings that biosimilars could offer to patients and taxpayers, it is well worth the effort to create well-crafted incentives.”