Report from Biosimilars Council highlights several warning signs that will affect adalimumab and future biosimilar adoption
WASHINGTON — The Biosimilars Council, the leading trade association representing manufacturers of biosimilar medicines, released an updated analysis showing how leading PBMs continue to manipulate biosimilar competition to their own profit at the expense of patients. The analysis of adoption trends among lower-cost biosimilar versions of Humira® shows that leading PBMs continue to prefer the high-priced brand despite biosimilar alternatives with discounts of more than 80 percent. Further, even though a major PBM has adopted a biosimilar, its adoption still trails that of PBMs and health plans that are not dependent on rebates, and it has used the biosimilar to drive more patients into its own pharmacies and away from competitor pharmacies. Finally, the data reveals the extent to which PBM rebate strategies favoring the brand manufacturer helped to not only delay patient adoption of lower-price biosimilars, but also to shift patients to new, higher-priced medicines.
“PBM strategies to profit from fees and rebates based on high list prices continue to drive coverage decisions to the detriment of patients, health plans and community pharmacies,” said Craig Burton, Executive Director, Biosimilars Council. “Even now, when one large, vertically integrated PBM now prefers Humira® biosimilars on its commercial formulary, it is not clear that this will result in sustainable biosimilar competition over the long-term rather than being merely the latest mechanism for vertically integrated PBMs to extract value that is not then shared with patients.”
In the past year, multiple biosimilar alternatives to Humira® launched in the U.S. Despite price discounts of greater than 80 percent, biosimilar adoption has been disappointingly slow, achieving less than two percent market share through March. Despite some gains in biosimilar adoption in April, two large PBMs limited biosimilar approvals to 1% and 5%, respectively, with brand Humira® maintaining control of 75% of the adalimumab market through May. In fact, the brand manufacturer’s immunology portfolio, consisting of three products, currently outnumbers all adalimumab biosimilar dispensing by a factor of 24 to 1. While biosimilar availability is delivering significant savings to the healthcare system, PBM preferences for high list price drugs and rebate games are stifling adoption of the biosimilars making these savings possible.
The IQVIA analysis continues to shine a light on the perverse incentives causing this slow adoption:
- Continued PBM reliance on rebates and fees that are tied to brand drug high list prices;
- PBM practices of rewarding their vertically integrated in-house specialty pharmacy networks compared to independent specialty and retail pharmacies.
- New PBM practice of promoting branded product through its own pharmacy channel.
