Incentives Drive Provider, Patient Biosimilar Adoption

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One notable incentive includes the launch of biosimilars at both low- and high wholesale acquisition costs.

Cost savings is part of the promise of biosimilar medications. But in order to deliver on that promise, providers must prescribe them, and payers must cover them. Since their introduction, manufacturers have implemented a variety of unique pricing incentives and strategies to incentivize biosimilar adoption. “Most recently, we have seen manufacturers take a non-branded and branded approach to the launch of their biosimilars, which offers a low wholesale acquisition cost [WAC] and a high [WAC],” explained Lakesha Farmer, Senior Director, Strategic Accounts, ION Oncology Practice Network at Cencora. This new pricing strategy is being used across therapeutic areas, from insulin biosimilars to the many biosimilars to adalimumab (Humira) that have launched since the start of 2023.

The dual WAC strategy, Farmer added, “caters to all payers and plans based upon preference and increases coverage and access to biosimilars for patients.”

Farmer also highlighted the strategies being implemented by the Mark Cuban Cost Plus Drug Company, which also aim to reduce out of pocket patient costs. For adalimumab biosimilar adalimumab-aqvh (Yusimry), for $569. The average cash price for adalimumab, Farmer said, $7300. “By offering this biosimilar at a cash price of $569 to uninsured patients—as well as [to] commercially insured patients with high deductibles, high co-pays, and high co-insurance—this patient-centered approach can be a game changer.”

From a reimbursement perspective, “the most notable incentive is the add-on payment for physician administered biosimilars, which was introduced under the Inflation Reduction Act,” Farmer said. “Under this provision, biosimilar reimbursement is stated as [average sale price] plus 8% of the reference product’s [average sale price],” which is higher than the add-on of 6% for reference products.

Farmer sat down with Drug Topics at AXS24, the Asembia Specialty Pharmacy Summit, held April 28 to May 2 in Las Vegas, Nevada. Click here for more of our coverage from AXS24.

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