James D. Chambers, PhD, MPharm, MSc Associate Professor of Medicine Tufts Medical Center Institute for Clinical Research and Health Policy Studies

Access to Pharmaceutical Biosimilars Varies with Insurance Plan

MedicalResearch.com Interview with:

James D. Chambers, PhD, MPharm, MSc Associate Professor of Medicine Tufts Medical Center Institute for Clinical Research and Health Policy Studies

Dr. Chambers

James D. Chambers, PhD, MPharm, MSc
Associate Professor of Medicine
Tufts Medical Center Institute for Clinical Research and Health Policy Studies

MedicalResearch.com: What is the background for this study?

Response: We know that biosimilars have not had the same uptake in the US as they have had elsewhere. We know that this is in part due to reference product manufacturer tactics to delay biosimilar market entry and patent disputes.

In this study we examined whether lack of preferred coverage by commercial health insurers may also play a role.

MedicalResearch.com: What should readers take away from your report? 

Response: That patients’ access to biosimilars is unequal across insurance plans. This means that physicians must tailor their treatment choices not only to a patient’s clinical presentation, but also to their insurance coverage.

Also, that a lack of preferred coverage by US health plans may be a factor in biosimilars mixed success to date.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We will continue to monitor how commercial health insurers cover biosimilars to determine if this trend continues. We also plan to extend this work to evaluate to what extent a lack of preferred coverage affects utilization, and also patient’s health outcomes. 

MedicalResearch.com: Is there anything else you would like to add?

Response: I would only like to add that this paper is part of our larger effort to better understand how health plans cover specialty products for their enrollees. The variation in biosimilar coverage we identified is consistent with variation we have found for specialty products more generally. However, given that the intent of biosimilars is to reduce costs, we were surprised by the lack of preferred coverage among many of the included commercial insurance plans.

I have no disclosures.

Citation:

Chambers JD, Lai RC, Margaretos NM, Panzer AD, Cohen JT, Neumann PJ. Coverage for Biosimilars vs Reference Products Among US Commercial Health Plans. JAMA. 2020;323(19):1972–1973. doi:10.1001/jama.2020.2229

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May 19, 2020 @ 4:48 pm 

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