Biosimilars: Launch Insights From the Field

Biosimilars hold great promise to reduce drug costs in the United States. Take, for example, the six drug classes with currently approved biosimilar products. If these biosimilars were able to capture 50 percent market share, they alone could save the healthcare system nearly $5 billion each year.

So what's keeping the biosimilars market from thriving? The fact is, everything from limited distribution networks to the limitations of health policy has contributed to stunted growth and minor market share. But there are also a few surprising factors I've noticed as I've led client strategy and business development for Xcenda's field services business and helped manufacturers navigate access barriers for biosimilars.

1. Parity in patient services

To date, the look and feel of patient support for biosimilars looks very similar to the reference drug. While this wasn't necessarily expected, it signals that the market standard for support has been set. It also means that as more biosimilars enter the market, success will only become more challenging. But it's not impossible.

While biosimilar patient support programs need to differentiate themselves to stand out from the pack, they can't be too different: Oncology and immunology providers expect biosimilars to compare favorably with the originators in terms of patient support, sales efforts, marketing tactics and more.

How to compete: Implementing a bridge program, which covers therapies until a prior authorization is processed, can differentiate a drug's support services by removing access hurdles and improving speed to therapy (essential for critical illnesses). A robust patient copay support program, on par with the originators, has also proven to be critical to provider and patient uptake of biosimilars. These programs give providers peace of mind in administering the first doses of a biosimilar while they await benefit verification.

2. A mixed market with aggressive originator positioning

Though the biosimilar market has been slow to grow when you look at the number of products launched, we now have nine products on the market with some of the industry's largest biologic manufacturers invested in the biosimilar market. In addition, innovator companies are putting significant effort into protecting their market share and challenging biosimilars' ability to earn a place on payer formularies and in physician offices. We're seeing originator manufacturers defend their product patents through litigation, additional discounts, exclusionary contracting and increased rebates to gain preferred status on payer formularies.

Consider the context: Because innovators came first, they often negotiate with payers, at times bundling contracts for multiple products with major insurers. For biosimilar manufacturers, entering that environment requires a team well-versed in the context and experienced enough to use those same payer tactics to their own competitive advantage.

How to compete: Given the complexities of biosimilars, invest in a payer strategy or partnership that will enable you to unlock efficiencies and insights to improve market access and coverage.

3. Practice economics remain a priority

Ultimately, biosimilar manufacturers who want to win market share must account for the physician experience in ways that break down barriers, delays and red tape.

Physicians want accessible products with a straightforward claims payment structure. If a biosimilar requires a formulary exception, clinicians aren't likely to see the value in choosing the longer process over the simplicity of an originator drug that the patient can start immediately.

How to compete: Physicians face financial pressure as it is. Any feature that enables greater access and convenience, while improving patients' lives, will inevitably win the script. For that reason, some biosimilars successfully offer generous extended-date invoicing, as much as 90 or 120 days. A biosimilar manufacturer should also offer field support for physicians, including a full team of reimbursement specialists able to act as subject matter experts and provide prescribers' staff with education on billing, coding, claim submission requirements, exceptions and appeals processes and more.

Parity where it matters, distinction where it counts

If biosimilars strike the right balance between parity and distinction, they're most likely to defeat the odds and increase their market share, just as generics did decades ago. The time is now, and the opportunities have never been better.