UnitedHealth Group, the nation’s largest health insurer, recently reported plans to stop covering Amgen’s Neupogen—a white blood cell-boosting drug often used by cancer patients—in favor of the biosimilar Zarxio in 2017. This move is a part of United’s efforts to increase biosimilar and generic drug use to reduce drug spending. Keep reading to see what this means for your program and how you can prepare for its impact.
A Brief Overview of Biosimilars
Payers see biosimilars as an opportunity to rein in spending on drugs
United and other payers are employing a number of strategies to increase biosimilar use in order to reduce drug spending. CMS, for instance, has decided to support biosimilar adoption by paying providers the same drug markup on biosimilars as they pay on the reference biologic (see below). United’s approach of excluding the brand-name biologic to stimulate biosimilar use is a more aggressive approach as it restricts physicians’ choices.
Refresher: CMS Reimbursement Methodology for Biosimilars
Clinicians may hesitate to prescribe Zarxio
Many clinicians are unfamiliar with biosimilars and may hesitate to prescribe Zarxio. According to a recent survey of 1,789 U.S. physicians, 8% said that they would not prescribe biosimilars and 48% said they “would need more educational information on biosimilars” before prescribing them. Consequently, cancer programs should take steps to ensure their physicians are comfortable prescribing Zarxio.
As more cancer drugs go off patent, the impact of biosimilars could be substantial
At present, there are very few biosimilars on the market that are used for cancer care and administered in the outpatient setting. So the impact of this type of coverage change on cancer programs is likely limited. But, there are a number of costly cancer biologics that are scheduled to come off patent in the next five years. Assuming a two year lag between patent-expiration and biosimilar launch, providers may see changes on additional part B cancer drugs as early as December 2017.
To make sure you are aware of any impending coverage changes, you should be in close contact with your contracting department. Let them know they should be on the lookout for coverage changes for biologics and biosimilars used in cancer care. If your infusion center offers non-cancer related infusions, then you’ll also want them to keep an eye out for coverage changes to other biologics used in your center.
Patient Expiration Dates for Five Widely Used Cancer Biologics