Drivers of Non-medical Rx Switching

Publication Date:
April 2020
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The strategies that are promoting wider use of biosimilars

Payers are highly motivated to realise the cost savings of biosimilars, but what strategies are they using to reassure and encourage physicians and patients? Budget impact models, establishing targets, real world evidence, guidelines and sharing savings between hospitals and payers all play a role. Biosimilar developers need to understand the trends and identify where they can positively engage.

Biosimilar switching is variable across the globe and this offers the opportunity to learn from those markets where switching is high and apply those lessons in markets where switching is low. That is why, in Drivers of Non-medical Rx Switching, we interviewed payer and industry experts who reveal the techniques and strategies that are being used to propel wider biosimilar adoption and use.

Experts explore key questions such as...

  • Is the pursuit of savings or cost effectiveness driving biosimilar switching?
  • Are the predicted savings from biosimilar switching being seen in real life?
  • How important are targets, financial incentives, tendering, RWE and national guidelines for encouraging switching?
  • How can prescriber attitudes act as a brake on biosimilar switching?
  • How important are patient preferences?
  • What practical role is there for manufacturers in encouraging stakeholders to switch?

What experts say...

"When it's biologics to biosimilars, it's clearly driven by cost. It's the biggest argument used by payers who are pushing for switching. Even biosimilar companies, when they launch their biosimilars, they do the health economic studies to show that with a biosimilar they can save a great amount for the healthcare system. So cost, definitely, is the biggest driver."
Global Portfolio Manager

"We were able to do those budget impact models like that and see significant savings. But now as you start seeing the agents that are used more in the outpatient setting, it's very difficult to do those analyses because you do see the cost savings when you just look at the cost and model that out, but it's offset by what your reimbursement and what your payer mix is. If your payer mix is primarily the state – so Medicare, Medicaid – then you might be okay switching to the biosimilar because that would be the preferred product, and the government has incentivised the use of those products and so you get additional reimbursement. But if your primary payer mix is private insurance, they may or may not have negotiated an additional rebate contract with the originator, and even though you do those cost analyses and assume that you'd be saving a significant amount of money by switching to the biosimilar, if you look at the reimbursement side, you're actually losing."
Manager of Medication Policy and Formulary Management

"Gain share agreements work particularly well. A proportion of the savings go back into the hospital. So, you might go for a 50:50 gain share between CCGs and hospitals – so 50 percent of the savings back to the hospital, 50 percent to the CCG. I know of one hospital where they were discussing over a three-year period where they would get 70 percent of the savings in the first year, then get 40 percent in the second, and then 10 percent in the third. The hospital will want to maximise its savings as quickly as possible and so will move patients over as quickly as possible."
Biosimilar Account Manager

What to expect

A detailed expert report exploring the drivers of biosimilar switching and the financial, physician and patient issues that biosimilar developers need to understand and engage with:

  • An examination of 15 key issues that influence switching to biosimilars
  • 17 targeted questions to US and European payer and industry experts
  • Their responses which provided 55 insights supported by 125 directly quoted comments

Expert contributors

The experts selected for this report all had relevant experience, including:

  • Working in a company/industry association actively involved in current switching and monitoring switching to biosimilars
  • Working at a payer or within a healthcare provider actively involved in current switching and monitoring future drug switching/biosimilars
  • Having published papers on switching
  • Knowledge of current trends in switching and biosimilars

To ensure candid views were expressed we have agreed to keep their identities anonymous.

The experts who contributed

  • A professor of rheumatology affiliated to a University Hospital in France, with direct experience of prescribing biosimilars and switching from originator biologics
  • A biologics pharmacist, working at a National Health Service (NHS) hospital in the UK, with responsibility for switching from biologics to biosimilars in the hospital and has published on exploring switching in practice
  • Biosimilars account manager with responsibilities for biosimilars at a top 10 global pharmaceutical company in the UK
  • Former business unit director at a top 10 pharmaceutical company with responsibility for planning a biosimilar launch in the UK
  • Pharmacist and manager of Medication Policy and Formulary Management at a non-profit healthcare system in the USA, with responsibilities for assessing the impact of switching from biologic to biosimilar
  • A Director for Biosimilars Access, Reimbursement and Health Economics at a top 10 global pharmaceutical company, with global responsibilities
  • A product manager at a drug manufacturer with a portfolio of biosimilars, based in Spain
  • A global portfolio manager at a pharmaceutical company with a portfolio of biosimilars, based in Germany

Why Choose FirstWord ExpertViews?

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  • Are based on primary research with experts whose knowledge and current experience is proven
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