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Surveyed U.S. Payers Expect Cost Savings to MCOs and Patients to be the Strongest Drivers of Biosimilar Uptake

Step Edits Are the Most Likely Strategy to Drive Use of a Biosimilar Priced 30 Percent Less than the Reference Brand, According to Findings from Decision Resources Group

BURLINGTON, Mass., July 30, 2014 /PRNewswire/ -- Decision Resources Group finds that the majority of surveyed pharmacy and medical directors in the United States believe that the key drivers of biosimilar market penetration will be the level of savings achievable by their managed care organizations (MCOs) and the expected lower cost to patients. Payers plan to leverage preferential reimbursement strategies for biosimilars that meet their pricing expectations in order to encourage physician prescribing of biosimilars over the reference brands; for example, if a biosimilar costs 30 percent less than its reference brand, 33 percent of surveyed U.S. payers would require step therapy with the biosimilar before the reference brand; other strategies include implementing favorable tiering and eliminating patient co-payments and co-insurance for biosimilars.

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Other key findings from the Biosimilars Advisory Service report entitled U.S. and EU Payer Perspectives on Biosimilars:

  • Biosimilars first: Interviewed European payers indicate that there is growing government pressure to prescribe biosimilars, exemplified by the "biosimilar first" polices that are emerging in Italy, Spain and France.
  • Pharmacy-level substitution: Payers' views on biosimilar pharmacy-level substitution continue to evolve in response to developing legislation in the United States and Europe, although payers' perception of the suitability of pharmacy-level substitution varies based on drug class.
  • Formulary inclusion: Biosimilars will be selectively chosen for formulary inclusion based on multiple factors of differentiation, including the strength of the clinical data supporting the biosimilar and the level of trust placed in the biosimilar developer. 
  • Competition from bio-betters: Innovator companies intending to offset losses of existing biologics under threat from biosimilar competition with 'bio-betters' should focus on an improvement in efficacy rather than improvements in dosing frequency to obtain premium pricing.

Comments from Decision Resources Group Analyst Anees Malik:

  • "In the U.S. healthcare market, which has seen unsustainable growth in expenditure over the previous decade, payers are planning to drive the adoption of biosimilars by synergistically delivering drug budget savings and decreasing patient out-of-pocket expenses."
  • "The message from payers is clear – not all biosimilars are created equal. There will be winners and losers. For biosimilar developers, understanding the value payers attach to each differentiation metric used to determine formulary inclusion and preferential reimbursement is of paramount importance. Particularly as the EU experience with tenders has taught us, the biosimilars space can behave as a winner-takes-all market."

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About Decision Resources Group

Decision Resources Group is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources Group at

All company, brand, or product names contained in this document may be trademarks or registered trademarks of their respective holders.

For more information, contact:

Decision Resources Group
Christopher Comfort
[email protected]

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SOURCE Decision Resources Group

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