New Report: Biosimilar Cost Savings Won’t Reach Patients

October 6, 2016

Since the advent of biosimilars, experts and pundits have debated how reduced biosimilar prices will be and just much savings the follow-on drugs will offer. Now, new research sheds light on a different topic: who actually will experience the cost savings. And it doesn’t seem to be patients.

According to IMS Health’s new white paper, “Biosimilars: Who Saves?,” patients may see less than five percent of the $25 billion in savings that the Congressional Budget Office expects biosimilars to generate by 2018. The analysts found that:

  • When savings are conveyed through a decrease in the drug’s list price, patients who pay a flat co-pay may not see any savings.
  • Patients who use an interchangeable biosimilar may see the most savings, as these drugs could be assigned to a lower formulary tier with reduced cost sharing.
  • Few patients if any will benefit if the savings are conveyed as drug rebates. These are given by manufacturers to pharmacies, pharmacy benefits managers or wholesalers, often in exchange for purchasing the drug at a certain volume.
  • Medicare Part D beneficiaries may actually pay more for biosimilars. (Manufacturers are required to offer 50 percent discounts for patients in the Part D coverage gap, the “donut hole.” But that requirement excludes biosimilars.)

With the biggest proportion of the savings staying with health plans and pharmacy benefit managers, the report posits, patients may fail to see the value of these therapies. In particular, those who already benefit from an innovator product may not be compelled to consider a biosimilar alternative. That, in turn, could mean limited use of biosimilars and less savings for the health care system.

For health plans to pass savings along to patients, they’ll need to look for more direct and creative mechanisms. The report suggests reducing premiums as one option.

To learn more, read “Biosimilars: Who Saves?”.

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