Choice is a politicized buzzword, but its significance does not diminish with use. In many ways, we have more choices today than we ever have.
Whether it’s the shows we watch, the coffee we drink, or how we get to our destinations—we have never had so many choices. But there is one area where our expectations have not been met: healthcare. For too long, patients have lacked the information and options needed to exercise meaningful choice and force competition on price. However, for the most expensive drugs, biologics, we are starting to see lower-cost alternatives. They’re called “biosimilars” and patients should be free to choose them.
Biologics—medicines derived from living organisms—are a major force behind rising drug costs. In 2017, biologics made up just 2% of U.S. prescriptions, but accounted for a whopping 37% of U.S. drug spending. When patients only have one biologic option, its manufacturer can set the price as high as it wants, and patients pick up much of the bill. Biosimilars—cheaper, interchangeable versions of biologics—compete on price, offering patients the choice to save on their prescriptions, sometimes many thousands of dollars.
However, of the 20 biosimilars approved by the Food and Drug Administration, only seven are commercially available today. Biosimilars offer the same safety and benefit as biologics at a lower cost, so why aren’t they seeing more uptake in the market? The answer is surprisingly simple: Biosimilar access is impeded by market incumbents focused on protecting profits. These market-blocking tactics take many forms, from misinformation campaigns to anti-competitive deals negotiated between pharmacy benefit managers and health insurers.
These anticompetitive deals are made under the premise of “rebates” on higher-cost drugs. Policymakers are not blind to these actions. Former FDA Commissioner Dr. Scott Gottlieb said, “The competition for biosimilars is weak, because the entire supply chain, including manufacturers, pharmacy benefit managers, group purchasing organizations and distributors, is more inclined to split monopoly profits by obtaining generous rebates from original biologics, instead of accepting competition of biosimilars and their lower prices.”
Rebates are offered in exchange for a preference position on the drug formulary, meaning the biosimilars end up “disadvantaged.” When a drug is disadvantaged, patients cannot access it unless they first try and fail on the more expensive biologic—effectively blocking patients from accessing biosimilars. This happened recently to pegfilgrastim, an essential drug given to chemotherapy patients. Amgen made a deal with UnitedHealthcare that forces physicians to prescribe Amgen’s Neulasta, the 33% more expensive biologic of pegfilgrastim, and blocks the less-expensive biosimilars, Coherus BioScience’s Udenyca and Mylan’s Fulphila.
Inability to access biosimilar savings can be devastating for patients, as too many are forced to choose between paying their electrical bill and keeping the lights on or paying for chemotherapy. It’s a decision I’ve seen too many patients grapple with. These anticompetitive deals not only deprive patients of the option to choose affordable drugs but also impede doctors from prescribing the drug they assess is best for their patient. Insurers should never come between the patient-doctor relationship—it’s a slippery slope with potentially devastating consequences.
With more than 1 in 3 Americans diagnosed with cancer in their lifetimes, how many will be less able to afford the care they need because insurers have blocked their access to cheaper biosimilar drugs? Patients deserve the right to choose the drug that works best for them, medically and financially, and a drug cannot work for them if they cannot afford it.
These drug-pricing games cannot continue. The need to reduce drug prices is one of the few things everyone in Washington can unite behind. Doctors need to be able to prescribe as they know best and patients need access to life-saving drugs they can afford. Biosimilars are the front line of the drug-pricing debate and without access to them, prices will continue to grow unchecked. It’s time for policymakers to protect biosimilar access.
