There has been great fanfare recently about a pharmacy benefit manager’s decision to market a biosimilar version of Humira, once the best-selling drug on the planet. Unfortunately, what began as a cause for optimism across the commercial health plans and employers that cover these medications could be a reflection of the longstanding trend toward increasing PBM dominance at the expense of patients.
Even after nine lower-cost biosimilars entered the market offering discounts of greater than 80 percent, and a major PBM adopted and preferred a biosimilar product within its standard commercial formulary, drug rebate games between the brand and major PBMs continue to stymie patient access to these lower-priced options.
AbbVie, the brand drug manufacturer that famously built a patent fortress around Humira, continued (and continues) to engineer incentives to block biosimilar adoption through PBM rebate schemes that prefer Humira over lower-priced biosimilars. What many hoped would be a golden age for biosimilars has yet to result, and patients continue to miss out on potential savings.
So, when one large, vertically integrated PBM announced the adoption of a biosimilar to replace Humira, there was hope that the move heralded a breakthrough in the marketplace. Competition will finally drive down costs for patients, right? The biosimilar market would boom and fulfill its promise, right?
Yes and no.
It is clear that this adoption of biosimilars, albeit limited, has benefited patients in the short term. However, a new analysis developed for the Biosimilars Council shows the power of PBMs to drive the adoption of products that benefit the PBM, regardless of whether patients benefit. It remains unclear whether biosimilars are on track for long-term sustainable competition or if this is just the latest mechanism for vertically integrated PBMs to extract value that does not benefit patients.
The analysis, conducted by independent healthcare firm IQVIA, shows how rebate shenanigans enabled the brand company to hold onto profits and also move patients to its newer, high-priced therapies instead of lower-priced biosimilars.
With the partnership of major PBM formularies, AbbVie continues to retain a large proportion of Humira patients while simultaneously achieving its goal of moving patients to its new, higher-priced medicines.
In fact, PBM formulary decisions have allowed AbbVie to shift far more patients to high-priced brands than have switched to biosimilars. As a result, its combined immunology portfolio volume currently outnumbers total biosimilar dispensing by a count of 24 to 1. For every patient benefiting from lower-cost biosimilar adalimumab, 24 patients are paying more than needed. Further, two of the “Big 3” vertically integrated PBMs continue to favor Humira, resulting in biosimilar dispensing rates of 1 percent and 5 percent.
Other successful models show how biosimilar adalimumab can benefit patients without anti-competitive behavior. For instance, Kaiser Permanente was able to switch 90 percent of commercial and Medicare patients to biosimilars more than a year ago. And it did so without relying on the kinds of financial shell games and supply chain domination that vertically integrated PBMs use. It seems clear that, concerning major PBM business practices, the more things change, the more they stay the same.
Generic and biosimilar medicines create competition that ultimately drives down costs for patients, employers, insurers and the healthcare system. To help the most people, we need a system that balances the need for innovation with the importance of patient access. This includes ensuring that PBMs prioritize coverage of lower-price biosimilars and generics.
Policymakers have made strides to shine a bright light on the PBM market and the need for critical reforms to protect patient interests and drive savings for the healthcare system. We must work together in a bipartisan fashion to stop these practices and fulfill the promise of biosimilar and generic drugs.
Craig Burton is the senior vice president of policy and strategic alliances for the Association for Accessible Medicines and the executive director of the Biosimilars Council.
Reprinted with Permission from DC Journal – By Craig Burton
The opinions expressed by columnists are their own and do not necessarily represent the views of AMAC or AMAC Action.
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Good article Mr.Burton, This whole issue of how some people are going to profit by selling their medicine and use all manner of chicanery to do that — it really goes against the grain of what healing is supposed to be about in a Nation that cares about fairness.Reading the Declaration of Independence it is obvious that the concept of fairness had a major part in the foundation of the United States of America. Healing is all about mind, body, spirit, and having Faith in God as well as knowledge of Anatomy and Physiology . And it should involve Ethics , trust, respect for those involved . So these Pharmacy Benefit Managers should be giving Ethics priority over profits. Your writing on this topic is appreciated Craig . I am 74, had first aid training , did some water quality examination using a microscope with camera attachment in the 1990’s , and have practiced anatomical drawing for the purpose of eventually being a medical illustrator — that has not happened — yet. Most of the past 50 years have been busy with tool making and tool design — some work on parts for navigation instruments and microscopes. Public Health and Public Health Law are of great importance and Ethical Standards surely have a place there . This mention of Biosimilars ( first time I have heard that word ) sounds encouraging ..
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