Likely focused on a best price policy, not a biosimilar-only policy, one of the largest national payers has announced that Amgen’s two new biosimilars to treat cancer will be accorded preferred formulary status over the reference agents. This formulary policy will be implemented January 1, 2020 for UnitedHealthcare’s (UHC’s) Medicaid and commercial plans (but not the company’s Medicare Advantage plan).
This action will also preclude other trastuzumab or bevacizumab biosimilars from obtaining preferred status at UHC once they are finally launched. This decision fuels Amgen’s business case for getting to the market first. No doubt, Amgen offered enticing discount and/or rebate incentives to achieve a lower net price than Roche currently offers.
One may also consider that Amgen obtained preferred status for Kanjinti® and Mvasi® as part of a portfolio or bundled contract. Amgen already has preferred status at UHC for its pegfilgrastim agent Neulasta® and the Onpro® on-body injector for Neulasta. With its currently available biosimilars and biologics for the oncology market, this strategy would make a lot of sense.
However, UHC did specify in its policy update that Sandoz’s Zarxio® (filgrastim) is the initial step required before proceeding to the longer-acting form pegfilgrastim. Regardless of UHC’s preference for Neulasta, this indicates that Zarxio will have to be tried first, restricting access to a degree. This policy change also is effective for the commercial and Medicaid (also referred to as UHC Community Plans) plans but not the Medicare Advantage plans.
As outlined in an earlier post, UHC preferred the originator brand Remicade® over the biosimilars (Inflectra® and Renflexis®).
This also demonstrates the nature of the moving target of best net costs. Nothing prevents Roche from increasing rebates or discounts to try to win back the UHC business.
In related biosimilar news… Seema Verma, Administrator of the Centers for Medicare and Medicaid Services, has reiterated the administration’s support for the Medicare International Price Index (IPI) drug pricing demonstration project. This initiative has been delayed from an expected proposed rule release of this past spring. According to the report, she did not specify when the rule would be made public, but stated it was a “top priority for my department.”