Can biosimilars lead us to affordability?

Topeka, Kansas (Jan. 30, 2024) – Prescription drug costs are undoubtedly a hot topic in our nation right now; and rightfully so. As leaders of the pharmacy team for Blue Cross and Blue Shield of Kansas, we are constantly looking for ways to improve affordability of prescription drugs for our members.

We put a lot of thought and research into what preferred products we should cover – taking our members’ best interests into consideration. One of the lights at the end of the tunnel may come in the form of biosimilar drugs.

Biosimilar drugs are relatively new to the prescription drug landscape and are becoming increasingly popular.

The introduction of biologics

For years, treating complex conditions like cancer, diabetes, Crohn’s disease and rheumatoid arthritis proved to be challenging and expensive. In 2003, the first blockbuster product, a biological drug, was approved in the U.S. This marked a significant turn in treating complex conditions.

Biological drugs, often called biologics, are complex drugs made from a living system, such as a microorganism, plant cell or animal cell. They’re different from your over-the-counter medications or typical pharmacy medications as they go through a separate, unique approval process with the Food and Drug Administration (FDA).

The cost of innovation

While innovation advances society, the cost of innovation often goes unconsidered. Years of development, research, clinical trials, patents and marketing went into these new, advanced biologics. As a result, these products are expensive.

The price of a biologic is significant and can cost more than $500,000 per year in some cases.¹ Hundreds of billions of dollars have been spent on biologic therapies. In 2021 alone, the U.S. spent $256 billion on biologics.² With the cost of these therapies now exceeding half of all dollars spent on ALL medications, what can be done about this rapidly growing spend? To combat these rising costs, health plans have typically used clinical programs, prescription savings programs and formulary management strategies. We may have a new opportunity to reduce costs, as there’s some relief in biosimilars.

The debut of biosimilars

A biosimilar is a product that is highly similar to another biologic that is FDA-approved. Biosimilar drugs typically cost less and show no clinically meaningful difference from biologic drugs in terms of safety and effectiveness.

The first biosimilar was approved by the FDA in 2015. Since then, 41 more biosimilars have been approved. Biosimilars improve access for patients by increasing the number of options available for use. These new options should also increase member access, improve member experience and drive total costs down. Some studies show that the U.S. health care system is projected to save nearly $40 billion with biosimilars, but with aggressive adoption of biosimilars, the system could save more than $100 billion.³ And the best part is, they are not meaningfully different on a clinical level from the original biologic, which we know is effective and safe!

Blue Cross and Blue Shield of Kansas’ role

As a member-owned, not-for-profit insurance company, our commitment to serve Kansans involves making decisions to promote better health and well-being for our members, while also being good stewards of their dollars.

Our pharmacy team works diligently to research and review what preferred products we should cover – with our members’ best interests being the primary driver. In making these determinations, cost is a key consideration, but our primary focus is on the safety and effectiveness of any drug. After reviewing all products for safety and effectiveness, our potential preferred products are carefully evaluated across multiple factors before a final decision is made.

These factors include availability of the product, member therapy disruption, member access, net cost of the product, the different benefit designs we offer and how product selection affects members of all benefit designs, among others. We balance all of this with the responsibility we have to our members to manage their premium costs.

What’s next

Biosimilars and biologics are FDA-approved medications that are effective and safe for the treatment of complex conditions. Having more products available increases access and availability for our members. Shifting the mindset to recognize the safety and efficacy of biosimilars will help drive a better market, and ultimately drive costs down.

To see the biggest health care cost savings for everyone, this takes buy-in from providers, hospitals, health plans and most importantly, our members. Our members are our top priority and our decisions on preferred products reflect that. BCBSKS is committed to helping our members have broad access to affordable, quality health care choices close to home – and this includes broad access to affordable, quality medication choices. We focus on safe and effective medication therapies, and the biologic space is no different. We are in an innovative world where biologics and biosimilars can co-exist in the market. When that happens, members win.

References:

1. Chen, Brian K et al. “Why Biologics and Biosimilars Remain So Expensive: Despite Two Wins for Biosimilars, the Supreme Court's Recent Rulings do not Solve Fundamental Barriers to Competition.” Drugs vol. 78,17 (2018): 1777-1781. doi:10.1007/s40265-018-1009-0
2. Commissioner, Office of the. “FDA and FTC Collaborate to Advance Competition in Biologic Marketplace.” U.S. Food and Drug Administration, FDA, www.fda.gov/news-events/fda-voices/fda-and-ftc-collaborate-advance-competition-biologic-marketplace. Accessed 26 Sept. 2023. 
3. “Projected US savings from Biosimilars, 2021-2025.” The American Journal of Managed Care, vol. 28, no. 7, 2022. Pp.329-335, https://doi.org/10.37765/ajmc.2022.88809.

About Blue Cross and Blue Shield of Kansas

For more than 80 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust with its members and contracting providers by providing outstanding customer service while quickly and accurately processing claims; fairly administering benefit plans and contracts; offering programs, services and tools to help members improve or maintain their health; and operating under the highest ethical standards while being good stewards of premium dollars. Blue Cross and Blue Shield of Kansas is an independent licensee of the Blue Cross Blue Shield Association and is the state’s largest insurer, serving all Kansas counties except Johnson and Wyandotte. For more information, visit bcbsks.com.