Biosimilars and the Future of Cost-Effective Care


By Sahily Paoline, Chief Clinical Officer at Xevant

The anti-inflammatory drug market is a cornerstone of modern rheumatology, with a projected growth of $139.80 billion by 2030. Medications like AbbVie’s Humira play a pivotal role in managing chronic inflammatory conditions. However, the emergence of biosimilars – near-identical copies of biologics with expired patents – presents a significant opportunity to disrupt the status quo and prioritize cost-effective patient care. As a healthcare professional focused on optimizing treatment access, I find this ongoing shift both intriguing and ripe for analysis.

A Strategic Powerhouse

Humira’s long-standing dominance can be attributed to several factors. Its broad treatment spectrum, coupled with aggressive marketing strategies and a strategic web of patents, solidified its market position. Notably, AbbVie adeptly leveraged patent laws to delay biosimilar entry into the US market. While such tactics raise ethical concerns, they reflect a broader industry trend of utilizing patents and rebates to shield high-cost specialty drugs from competition.

Further solidifying their market presence, AbbVie established strategic partnerships with major healthcare providers like CVS Health for co-branded Humira distribution. This guaranteed continued availability through key channels, potentially influencing physician prescribing habits and reinforcing Humira’s status as the default choice.

AbbVie’s Proactive Approach

However, AbbVie recognized the impending biosimilar threat. They proactively launched Skyrizi and Rinvoq, aggressively promoting these newer biologics with even wider treatment spectrums. These strategic maneuvers position Skyrizi and Rinvoq to potentially surpass Humira’s peak performance. Additionally, AbbVie’s recent investment in OSE-230, a potentially groundbreaking anti-inflammatory therapy, underscores their commitment to remaining a leader in this lucrative market segment.

Lower Costs, Lower Adoption

Despite the compelling economic advantages of biosimilars, their adoption for anti-inflammatory drugs remains surprisingly low. Biosimilars offer substantial cost savings, with discounts on Humira’s wholesale acquisition cost (WAC) ranging from 5% to a staggering 86%. Yet, the collective market share of biosimilar alternatives for Humira remains stubbornly low at around 1%.

Overcoming Hurdles

Several factors contribute to this disparity. Pharmacy Benefit Managers (PBMs), who wield significant influence over formulary access and prescribing decisions, play a critical role. While the three largest PBMs have updated their formularies to include biosimilar options, some may require additional incentives to prioritize cost-effective alternatives. Additionally, healthcare providers may need further education and outreach to fully understand the clinical equivalence of biosimilars and feel confident in prescribing them.

Market disruptors like Mark Cuban Cost Plus Pharmacy are leading the charge for transparency. Their partnership with Coherus to offer Yusimry, a Humira biosimilar, at a significant discount, exemplifies this dedication to affordability.

Collaboration for Cost-Effective Care: A New Era for Anti-inflammatory Treatment

Moving forward, a multi-faceted approach is necessary to unlock the full potential of biosimilars. Firstly, robust data analytics are crucial for PBMs to make informed formulary decisions. Advanced platforms like Xevant’s analytics suite can predict drug utilization trends and evaluate the cost-effectiveness of new treatments, ensuring optimal formulary management that prioritizes both efficacy and affordability.

Secondly, healthcare providers require ongoing education and outreach programs. Equipping them with data-driven insights on biosimilar efficacy and cost benefits will fuel them to make informed prescribing choices that align with best practices and patient needs.

Finally, fostering open collaboration between PBMs, healthcare providers, and biosimilar manufacturers can create a win-win situation. PBMs can incentivize biosimilar adoption through formulary design and reimbursement strategies. Providers can confidently prescribe these cost-effective alternatives, and patients gain access to high-quality treatments that don’t strain their wallets.

While AbbVie continues to leverage its established brand presence, the winds of change are undeniable. By embracing biosimilars, harnessing the power of data analytics, and prioritizing patient affordability, we can usher in a new era of cost-effective and sustainable healthcare for all stakeholders.