The move away from Johnson & Johnson’s originator product has been slow, due to the Pfizer’s flawed launch pricing of its biosimilar, J&J’s actions to defend marketshare, and residual reluctance by gastroenterologists to switch patients whose Crohn’s disease is in remission with Remicade®. According to March data from Bernstein Research, Remicade maintained about 81% marketshare in the US.
One perceived barrier to biosimilar uptake has been the lack of a consumer incentive to switch from a reference product. The vast majority of health plans and insurers have not yet implemented lower cost sharing for biosimilars. This was partly because no biosimilar has been covered under the pharmacy benefit, with its varied and flexible copay and co-insurance tiers.
Without the member’s motivation to save money, biosimilar marketshare may be more dependent on payer formulary decisions and provider reimbursement policies. Whereas the uptake of the oncology biosimilars has equaled or outpaced the reference products in a short time span, the same cannot be said for the infliximab category.
In the past, health plans and insurers have attempted to persuade members to change their preferences or behaviors through a bevy of incentives. For example, if a person enrolled in a 1990s disease management program, they would get a free gym membership. If they agreed to a 2010 medication therapy management review, they might receive a gift card.
Cigna is poised to use this tactic in its new biosimilar policy. increase member willingness to switch to a biosimilar. The insurer announced that beginning in July, it will move two infliximab biosimilars to preferred status. It will offer a one-time $500 gift card to patients who were taking the reference product Remicade and switch to either Avasola® or Inflectra®.
In the post, Cigna’s Chief Clinical Officer, Steve Miller, MD, wrote that the company was paying on average $30,000 per year for Remicade, but this figure could be higher based on sites of infusion. Cigna is offering the gift card not only for switching to an infliximab biosimilar, but also if the patient switches to a preferred medicine in a related autoimmune class.
In correspondence with Fierce Healthcare, Dr. Miller explained that this biosimilar switching incentive, called the Shared Savings Program (sound familiar?), will be rolled out to 7000 eligible Cigna members.
The offer was piloted to members who were given the opportunity to switch from the interleukin 17A–inhibiting medication secukinumab (Cosentyx®) to the insurer’s preferred agent for treating psoriasis, ixekizumab (Taltz®).
Apparently, the organization wants to save money on the utilization of these expensive specialty biologics. The gift card program gives members a chance to “share in the savings,” but quite unlike Medicare does with its own shared savings programs.
Until cost-sharing policies are changed for biosimilars, this biosimilar switching incentive may be the most direct approach to demonstrating a financial impact to consumers, even if it is a one-time giveaway. If this approach works and saves Cigna significant money, expect the same to be used with the first biosimilar adalimumab preferred by the insurer in 2023.
In other biosimilar news…Samsung Bioepis and Biogen announced a positive opinion by the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) on its ranibizumab biosimilar SB11. A decision from the US FDA is expected in the fourth quarter of this year.
