Biosimilar Uptake in Medicare Part B Varied Across Hospital Outpatient Departments and Physician Practices: The Case of Filgrastim

Socal, Mariana P.; Anderson, Kelly E.; Sen, Aditi P.; Bai, Ge; Anderson, Gerard F.

doi:10.1016/j.jval.2019.12.007

Cited by 21 publications

(16 citation statements)

References 3 publications

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“…19 In addition, Socal et al used the 2015-2017 Medicare Part B claims data and found an improved uptake of biosimilar filgrastim in the Medicare Part B program. 20 This study used the most recently available Medicare and Medicaid drug spending data to evaluate the uptake and cost of filgrastim-sndz, relative to its originator filgrastim and alternative biologic tbo-filgrastim, among Medicare and Medicaid populations in 2015-2018.…”

Section: What This Study Addsmentioning

confidence: 99%

Uptake and cost of biosimilar filgrastim among Medicare and Medicaid populations in 2015-2018

Qian

2021

JMCP

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BACKGROUND:The first biosimilar product filgrastim-sndz was approved by the FDA in 2015, but real-world evaluations of its uptake and cost in nationally representative populations are limited. OBJECTIVE:To evaluate the uptake and cost of filgrastim-sndz, relative to its originator filgrastim and alternative biologic tbofilgrastim, among Medicare and Medicaid populations. METHODS: Using the annually aggregated, product-level utilization and cost data of biologic and biosimilar filgrastim products in 2015-2018 from CMS drug spending data, total number of claims and costs for all 3 filgrastim products were identified and extracted for Medicare Part B, Part D, and Medicaid reimbursement. Annual average cost per claim and per beneficiary of individual filgrastim products were also extracted, and their annual growth rates were calculated. RESULTS: Three years after entering the US market, use of filgrastim-sndz increased to 49.1% and 46.0% of all filgrastim claims paid by Medicare Parts B and D, respectively, and to 38.7% of filgrastim Medicaid claims in 2018. Total cost for filgrastim-sndz also reached 42.8%, 41.8%, and 26.9% of all filgrastim products paid by Medicare Parts B and D and Medicaid, respectively. Significant reductions in average cost per claim for filgrastim-sndz in 2017 and 2018 were observed in Medicare Part B and Medicaid. CONCLUSIONS: Significant uptake of biosimilar filgrastim in Medicare and Medicaid programs occurred during the first 3 years of marketing. Policymakers may use the evidence to evaluate existing barriers and policies regarding biosimilar adoption.

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Section: What This Study Addsmentioning

confidence: 99%

Uptake and cost of biosimilar filgrastim among Medicare and Medicaid populations in 2015-2018

Qian

2021

JMCP

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“…5 Under this policy structure, however, biosimilar uptake remains low and prices remain high, differing from the experience in the US Department of Veterans Affairs and European health care systems. [6][7][8][9][10][11] For example, in quarter 3 of 2018, Remicade (infliximab) still maintained 81% of the Medicare Part B market share of Remicade and 2 approved biosimilars, Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda), even though the biosimilars were priced at a 17% to 23% discount off of the Remicade cost. 12 Given this background, 2 key gaps remain in the literature.…”

Section: Introductionmentioning

confidence: 99%

Association of Generic Competition With Price Decreases in Physician-Administered Drugs and Estimated Price Decreases for Biosimilar Competition

Dickson

Kent

2021

JAMA Netw Open

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IMPORTANCEPrice decreases of biologic and biosimilar products in Medicare Part B have been minimal, even with biosimilar competition. Medicare reimburses clinicians for biologics and biosimilars differently than for brand-name and generic drugs, which has generated greater price reductions. OBJECTIVE To characterize the nature of price competition among brand-name and generic drugs under Medicare Part B and to estimate the cost savings to the program of subjecting biologic and biosimilar therapies to a similar price competition. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed all brand-name drugs and their approved generic versions as well as biologics and biosimilars that were reimbursed under Medicare Part B from quarter 1 of 2005 to quarter 2 of 2021. Two separate data sets were created: brand-name and generic drugs as well as biologics and biosimilars data sets. Brand-name products with generic versions that were introduced before 2005 were excluded, and so were vaccines. EXPOSURES Number of generic and biosimilar competitors over time. MAIN OUTCOMES AND MEASURES Price change as a percentage of the brand-name drug or biologic price in the quarter before generic or biosimilar competition. Price change was modeled using a linear, fixed-effects time series regression, with the number of generic or biosimilar competitors as the main covariate. Time was expressed as the number of quarters since the first generic or biosimilar competitor entered the market. Savings were estimated by projecting the regression model of brand-name and generic drug competition to observed biologic and biosimilar competition and by applying the estimated price reduction to actual Medicare spending for those products from 2015 to 2019. RESULTSOf the 988 Healthcare Common Procedure Coding System codes identified, 50 (5.0%) met the inclusion criteria for the brand-name and generic drug data set and 28 (2.8%) met the criteria for the biologic and biosimilar data set. The first generic competitor was associated with reduced drug prices by 17.0%, the second competitor with a 39.5% decrease, the third competitor with a 52.5% decrease, and the fourth and more competitors with a 70.2% decrease (price decline was measured from brand-name drug price before the first generic competitor rather than from price established with fewer competitors). If biologics and biosimilars were subject to the same Medicare reimbursement framework as brand-name and generic drugs, Medicare spending on these products was estimated to have been 26.6% lower ($1.6 billion) from 2015 to 2019. CONCLUSIONS AND RELEVANCEThis study found minimal uptake of biosimilars and limited price reductions for biologics and biosimilars under the current Medicare Part B reimbursement policy.(continued) Key Points Question Is generic drug competition associated with prices of physicianadministered drugs, and what price changes could occur under increased biosimilar competition? Findings In this cohort study of 50 brand-name drugs and generic versions as well as 28 biologics a...

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“…This work supports previous evidence from studies of filgrastim, which suggest that patient characteristics are not strongly associated with biosimilar use. 15 Adjusted analyses controlling for patient and practice characteristics found that both physician specialty 15,16 and physician prescribing volume 15 of a given drug class remained strongly associated with biosimilar use. Although results were not consistent in the filgrastim drug class, physicians with a higher volume of prescriptions were generally more likely to prescribe biosimilar products.…”

Section: Discussionmentioning

confidence: 99%

Physician, Practice, and Patient Characteristics Associated With Biosimilar Use in Medicare Recipients

2021

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Key Points Question What patient, physician, and practice characteristics are associated with biosimilar usage for the biologics filgrastim and infliximab? Findings In this cross-sectional study of 40 656 Medicare fee-for-service beneficiaries, few patient and physician characteristics were associated with biosimilar usage. Practice setting characteristics had the largest associations; however, the types of practices with high biosimilar use differed by drug class. Meaning In this study, practice setting and hospital ownership status were associated with use of biosimilars, but further research is needed to understand the reasons for differences across drug classes.

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Biosimilar Uptake in Medicare Part B Varied Across Hospital Outpatient Departments and Physician Practices: The Case of Filgrastim

Cited by 21 publications

References 3 publications

Uptake and cost of biosimilar filgrastim among Medicare and Medicaid populations in 2015-2018

Uptake and cost of biosimilar filgrastim among Medicare and Medicaid populations in 2015-2018

Association of Generic Competition With Price Decreases in Physician-Administered Drugs and Estimated Price Decreases for Biosimilar Competition

Physician, Practice, and Patient Characteristics Associated With Biosimilar Use in Medicare Recipients

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