The Cost of Biologics and Biosimilars

Amanda Forys, MSPH: We’re going to talk a little bit about cost, access, and education, and a little bit about patient assistance programs and how these fit in with the whole biosimilars marketplace.

The first thing I want to talk about is just the cost of biologics. We know that biologic products are a little bit more expensive than what we’ve traditionally seen in the market. Now that the biosimilars are coming out, we’ve seen discounts up in the 15% to 20%, some things in the 20% to 30% [range], we’re not really sure where it’s going to go with policies that are still being figured out among payers about biosimilars.

Just in general, what are patients paying for biologics, how is that affecting them, and is it affecting them in their outcomes or their financial health? What are you seeing with the current biologics market?

Christy M. Gamble, JD, DrPH, MPH: What we’re seeing [is] the average daily cost of a biologic is $45, versus a non-biologic which is $2. That is an extremely significant difference, and for patients, it is a shock to the system.

What we’re seeing is, you have patients that can afford [biologics] and cannot afford [biologics]. So, for the patients that cannot afford, they’re having to, like I said, resort back to those outdated medications, and they’re being left out of healthcare innovation. They’re dealing with adverse effects from these older medications that they wouldn’t have to [deal with otherwise], and they’re not able to have access to the medication that could effectively treat their disease state versus those who can or are willing to pay. They’re willing to take that risk “at all costs,” so to speak, just to get access to the medication.

So we’re hearing patients say, “I have to decide whether or not I’m going to sell or mortgage my home just to afford this medication. But I have to do what I have to do, because I need to treat and manage this disease.”

It’s unfortunate, because we don’t want patients to have to mortgage their life just to afford medication, and that’s what we’re seeing right now with biologics.

Amanda Forys, MSPH: Yes, and it’s interesting, you raise the drug cost and then on top of that you’ve got the administration fees and visiting the provider, and while some of these programs have out-of-pocket caps, they’re very high. Some of them are extremely high, and you’re looking at people paying—if they’re getting into these programs, and having an almost catastrophic health plan where they’re paying an almost $10,000 out of pocket max, or even some of them at a $5000 to $7000 deductible before the care starts. I think we’ve got an expensive drug, and in addition we’ve got a payer market that’s being designed around very high buy-in costs for a patient’s care to kick in, or their coverage to kick in.

Christy M. Gamble, JD, DrPH, MPH: Absolutely.

Amanda Forys, MSPH: It’s a double-edged sword.