Looking Back to Go Forward: What 2023 Has Taught Us About Biosimilar Adoption

The year 2023 was anticipated to bear witness to a breakthrough in our country’s decades long struggle with high drug prices. The number one product by drug spend in the United States was adalimumab (Humira; AbbVie) which hit a record $18.6 billion in sales for 2022, was set to have multiple biosimilar competitors enter the US health care market in 2023.^1,2 Anticipation built as the products began to launch in the mid-summer, but at the close of the year many stakeholders were left wondering when things were going to change. Despite the availability of multiple biosimilars at lower costs, some discounted as much as 85%, the adalimumab biosimilars collectively have seen minimal uptake to date, putting the US health care market further behind the curve in realizing the progressive savings offered by these lower cost medicines.³

Fortunately, it is early in the process and the jury is still out on how this story will end. It is imperative that 2024 be the year we see acceptance and uptake of biosimilars to reduce health care costs and encourage greater investment in the development of these effective and lower cost medications.³

Biosimilar Adoption

Biosimilars by design are intended to provide patients with effective treatment options at a reduced cost. But in the United States, they are still underutilized, even as Europe continues to rack up substantial savings from its progressive adoption of biosimilars. The complexities of the US health care market, low awareness of biosimilars, and a reluctance by health care practitioners (HCPs) and patients to try biosimilar medications all have played a significant role in the slow rolling launch of adalimumab biosimilars in 2023.³

The complexities of the US health care market, low awareness of biosimilars, and a reluctance by health care practitioners (HCPs) and patients to try biosimilar medications all have played a significant role in the slow rolling launch of adalimumab biosimilars in 2023. Image Credit: © Thapana_Studio - stock.adobe.com

In my role, I have witnessed a concerted effort by biosimilar advocates to educate key stakeholders on the value these medicines can provide within the US health care market. Although, if truth be told, we need to do better if biosimilars are ever going to reach the acceptance that generics have achieved in the United States. Early on, when the first infliximab biosimilars were launched in 2016, the US market showed little desire to embrace these new treatment options.³

Fortunately, the market is better-informed today. There was significant uptake in utilization of several cancer-related products, with some categories achieving 80% biosimilar share.3 Unfortunately, the rate of adoption in other therapeutic categories such as insulin and adalimumab have not mirrored the experience with these oncology classes. If we’ve learned anything from 2023, it is that there is an urgent need for policies that will accelerate biosimilar use to achieve lower system-wide health care costs.³

The disappointing rate of adalimumab adoption in 2023 reveals how difficult it can be for biosimilars to gain meaningful traction in the US market. The decision on if and when a biosimilar can be accessed by an HCP and patient is not simply based on price, value-added services, device design, or supply reliability amongst other product attributes. There are health care delivery networks, commercial payers, pharmacy benefit managers, and many other stakeholders who all take varying approaches to biosimilar adoption. Different business models are based on differing priorities, and many times these priorities inhibit biosimilar adoption in the United States, despite the potential savings to our health care system as a whole.³

In 2023, we have seen biosimilar manufacturers use various discounting tools and pricing strategies to incentivize market access to biosimilars. Consequently, some manufacturers of originator products modified their strategy to offer unbranded formulations of their branded reference product and made other changes to their pricing strategies to preserve market share. Moving forward into 2024, biosimilar manufacturers will need to continually demonstrate how their pricing strategies for their products provide a long-term cost advantage relative to the reference product and advocate for each and every patient to have the option to utilize a biosimilar just as they might use a generic medication.³

Prescribers don’t often think of a biosimilar option in the same way they think of generic molecules. It’s true that biosimilars for large molecule originators are not the same as generic versions of small molecule originators, but the economic premise is similar. Generics and biosimilars can both be a fraction of the cost of the originator product. Thus, for a patient paying a percentage of wholesale acquisition cost or those without access to copay or discount cards, the price difference can be substantial. Perhaps in 2024, we will start to hear more discussion of a biosimilar-only formulary tier, similar to the design of generic tiers, especially as planning evolves for 2025.³

2024 will also bring an opportunity for the biosimilar community to continue their efforts in education. Patients often do not understand there are no clinically meaningful differences between a reference biologic and its biosimilar equivalent. There is a need for HCPs, pharmacy associations, employers, trade groups, and patient advocacy organizations to engage their communities and educate on the quality, reliability, and cost benefits of biosimilars. Many of these groups have in fact worked to educate their prescribers and patients about biosimilars, and a few health systems have given priority access to biosimilars because of the cost savings potential. These examples could be shared through publications and professional forums. The more our society learns of and accepts the value of biosimilars as lower cost alternatives to high-priced originator biologics, the sooner we will see real momentum in drug cost savings to our health care system.³

Biosimilars can save Americans billions of dollars on drug costs. In the United States, we often hear about the high price of medications, but the potential savings biosimilars can offer, and the market-driven barriers to their broader adoption, have not yet become an integral part of the public discourse on health care costs. It is imperative to all stakeholders within the US health care system—from manufacturers to patients—that we see an uptake in market penetration for biosimilars in 2024. This will allow the US health care system to realize much needed reductions of drug costs and further incentivize manufacturers to develop more biosimilars for other high cost products.³

About the Author

Thomas Newcomer, MBA, is the vice president and head of U.S. market access at Samsung Bioepis, a global biopharmaceutical company focused on biosimilars.

REFERENCES

1. Mikulic M. Leading 10 prescription drugs based on U.S. sales in 2022. Statista. October 19, 2023. Accessed December 18, 2023. https://www.statista.com/statistics/258010/top-branded-drugs-based-on-retail-sales-in-the-us/
2. AbbVie Reports Full-Year and Fourth-Quarter 2022 Financial Results. Chicago, IL: AbbVie; February 9, 2023. Accessed December 18, 2023. https://investors.abbvie.com/news-releases/news-release-details/abbvie-reports-full-year-and-fourth-quarter-2022-financial
3. Newcomer T. Biosimilar Market Report 2nd Edition, Q3 2023. Samsung Bioepis. 2023. Accessed December 18, 2023.https://www.samsungbioepis.com/upload/attach/SB+Biosimilar+Market+Report+Q3+2023.pdf