Optimizing Biosimilar Competition in the U.S. Market
Beginning in 2023, five years after their European counterparts, patients in the United States who … [+]
Patients in the United States prescribed the autoimmune disease treatment Humira have been eagerly anticipating the availability of lower-priced biosimilars since 2023, following in the footsteps of their European counterparts. However, the complex rebate system utilized by drug manufacturers and pharmacy benefit managers (PBMs) in the U.S. has hindered optimal biosimilar competition, resulting in high out-of-pocket costs for patients.
PBMs play a crucial role in negotiating prescription drug prices and managing formularies, which are lists of covered pharmaceuticals. Rebates are a key component of this system, with drug makers offering PBMs financial incentives to secure favorable formulary positioning. While these rebates may lower net prices, patients often do not directly benefit from them, as their out-of-pocket costs are based on list prices rather than net prices.
To increase the uptake of preferred drugs, PBMs can use various tactics such as less restrictive reimbursement conditions and formulary exclusions. These exclusions can create barriers for non-preferred products, including biosimilars aiming to compete with established brands like Humira.
Despite the availability of over ten authorized biosimilars for Humira, their market share in the U.S. remained low at only 2% by March 2024. This lackluster performance can be attributed to rebating strategies employed by the originator company, AbbVie, to maintain Humira’s dominance in the market.
Recent developments have shown a shift in the market dynamics, with major PBMs like CVS Caremark and Express Scripts making strategic changes to their formularies. CVS Caremark, for instance, removed Humira from its commercial lists and replaced it with preferred Humira-referenced biosimilars, leading to a significant increase in biosimilar uptake.
Similarly, Express Scripts is launching its private label Humira-referenced biosimilar, adalimumab-adbm, to provide patients with more affordable options. However, these moves may inadvertently steer patients towards specific products favored by the PBMs, potentially limiting the uptake of other biosimilars in the market.
While these strategies aim to reduce costs for patients, they also highlight the complexities of the rebate system in the pharmaceutical industry. The interplay between drug manufacturers and PBMs can create challenges for optimizing biosimilar competition and ultimately impact patient access to affordable treatments.
As the market continues to evolve, insurers and stakeholders are exploring alternative approaches to disrupt the rebate-driven model. The landscape of biosimilar competition in the U.S. is poised for change, but the full impact of these initiatives remains to be seen.
Overall, the journey towards optimizing biosimilar competition in the U.S. market is a complex and dynamic process that requires collaboration between industry stakeholders to ensure affordable access to innovative treatments for patients.
As we move into a new year, it’s important to take a moment to reflect on the past year and set goals for the year ahead. Setting goals is a powerful way to focus our energy and efforts on what truly matters to us, and can help us achieve success in both our personal and professional lives.
One of the most important aspects of setting goals is making sure they are specific and achievable. Vague goals like “lose weight” or “get in shape” are less likely to be achieved than more specific goals like “lose 10 pounds by June” or “run a 5k race in September.” By setting specific goals, we are able to track our progress and stay motivated to continue working towards them.
Another key factor in setting goals is making sure they are realistic. It’s great to aim high and challenge ourselves, but setting unrealistic goals can lead to frustration and disappointment. Instead, it’s important to set goals that are challenging yet attainable, so that we can feel a sense of accomplishment when we reach them.
It’s also helpful to set both short-term and long-term goals. Short-term goals can help us make progress quickly and keep us motivated, while long-term goals give us something to work towards over a longer period of time. By setting a combination of short-term and long-term goals, we can create a roadmap for success that will keep us on track and moving forward.
In addition to setting specific, achievable, and realistic goals, it’s important to regularly review and adjust our goals as needed. Life is constantly changing, and our goals should be able to adapt to those changes. By regularly reviewing our goals and making adjustments as needed, we can ensure that we are always working towards what truly matters to us.
As we enter a new year, take some time to reflect on your goals and set new ones for the year ahead. By setting specific, achievable, and realistic goals, and regularly reviewing and adjusting them as needed, you can create a roadmap for success that will help you achieve your dreams and live your best life.
