Magellan Rx Pharmacist: Cost Savings Potential if Oncology Biosimilar Utilization Increased

Jim Rebello, PharmD, is the vice president of Formulary Strategies at Magellan Rx Management.

What are the potential cost savings that payers could see if biosimilar use was increased in the oncology space?

It's certainly going to vary, depending on a lot of factors, such as what line of business this is in, how the fee schedules are set up from from plan to plan, site of care. All those factors are going influence things. We know the list price of the drugs and we typically see [discounts between] 15% to 20%. So, I think that's a good safe number to use, if someone's just trying to project over a general population without having any data in front of them. That's a good number. But I will say, we're seeing, in a really large sample of health plans that we work with, that those numbers can be greater. They can be a lot more than 15% to 20%. We've seen 25%, 30%, and 40% less, depending on the plan. When you look at CMS' ASP [average sales price], it's also a good indicator. We're starting to see the biosimilar ASPs drop pretty fast, which is certainly faster than the originator products, at least at this point. So, that leads me, at least, to think that we're going to see hopefully even beyond 15% to 20%. Even if it was only 15% to 20%, because the spend in this category is so big, that still yields a lot of savings. But I think, for payers, even though the [biosimilar] may cost 15% to 20% or even double that less [than the reference product], the only way you get the savings is if utilization moves over to those [biosimilar] products. So, it's a great opportunity but if the utilization doesn't change, then the savings are, unfortunately, only theoretical.