Pharmacists Believe Lack of Interchangeability Information and Designations Pose Real Barrier to Biosimilar Adoption

How do payers and health systems view the barriers to biosimilar adoption in October 2020? A survey by the Academy of Managed Care Pharmacy (AMCP), the AMCP Foundation, and its partners revealed the latest views of a group of healthcare stakeholders.1

The poster presented at last week’s Academy of Managed Care Pharmacy’s (AMCP) Nexus meeting yielded preliminary data from the survey, demonstrating interesting trends on barriers to biosimilar adoption. The results of this survey offered a bit of a contrast to previous survey findings (which also included several groups of stakeholders, with pharmacists comprising nearly three-quarters of respondents).

In a 2018 study, researchers from AMCP found that the most likely strategies to advance biosimilar uptake, according to surveyed payers, involved federal and state policies, prescriber education on real-world studies, and explicit guidance from the FDA guidance on biosimilar substitution. For the 2020 study, several questions were modified and the pool of respondents did not replicate that in 2018. The researchers acknowledged that as a result, limited comparisons can be made between the two surveys. Yet, based on the 2020 study sample of more than 200 payers and health systems, it seems that priorities have shifted slightly (Table).

1. Expanded Medicare/Medicaid Policies1. Clear FDA Guidance on Interchangeability
2. Prescriber Education on Real-World Studies2. Interchangeability Studies
3. Formulary Policies that Promote Biosimilar Use in Treatment-Naïve Patients3. Formulary Policies that Promote Biosimilar Use in Treatment-Naïve Patients
4. Clear FDA Guidance on Substitution4. Medicaid/Medicare Policies to Encourage Biosimilar Use
5. Medicaid/Medicare Policies to Encourage Biosimilar Use5. Reduced Cost-Sharing for Patients Using Biosimilars

In the current study, the vast majority of 17 strategies specified by the researchers were considered useful in improving biosimilar adoption. Yet the emphasis seems to have moved subtly away from switching and towards interchangeability as the top strategy to improve biosimilar uptake. In 2018, aspects in interchangeability ranked only number 8, but just two years later, occupied the top 2 spots. Again, the comparability of these two surveys is very limited, so this statement would need to be considered with caution.

From a managed care policy perspective, the main attraction of interchangeability is that such a product can be automatically substituted at the pharmacy. From a practical standpoint, however, this is beginning to seem like a mirage that draws no closer.

The current, real-world situation is this: The concept of interchangeability is not directly applicable to a drug covered on the medical benefit, and essentially all biosimilars marketed today are covered under medical benefit (with the possible rare exception of pegfilgrastim prefilled syringes, which can be self-injected).

The first potential interchangeable product could be one of the adalimumab biosimilars, which will first be marketed in 2023. Yet, even if Boehringer-Ingelheim did receive the FDA designation, this would not guarantee that payers will prefer Cyltezo®. This agent will face competition from at least six other agents released throughout that year.

The research group reported that health plans and PBMs are considered most influential in improving biosimilar uptake, at 43% of respondents. “Employer groups, professional
associations and commercial manufacturers appear to be
least likely to be influential (<5% for each),” they stated.


  1. Chung I, White A, Spain J, et al. Overcoming biosimilar barriers: Stakeholder perspectives on strategies to overcome challenges—a cross-sectional study (poster). Presented at AMCP Nexus 2020, October 20–23, 2020.

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