February 2023 Newsletter

March 8, 2023

ASBM and GaBI Spring Webinar Series to Examine Inflation Reduction Act

 

In April and May, ASBM and the Generics and Biosimilars Initiative (GaBI) will host two new webinars examining the implications of the recently-passed Inflation Reduction Act (IRA). The webinars will focus on the unintended consequences that may result from the implementation of IRA provisions. For example, provisions intended to reduce the expenses of biologic medicines in the short term may result in fewer medicines being introduced in the long term, reducing rather than increasing patient access to innovative treatments.

 

Presenters will discuss cost containment efforts in different countries and examine the impact these policies have had on patient care and healthcare professionals.

 

The new webinars build on the success of ASBM and GaBI’s Summer 2022 webinars, the first of which looked at factors which contributed to successful biosimilar uptake in the U.S. and Europe and was the basis for a whitepaper in GaBI Journal’s Q4 2022 issue. The second examined the controversial policy of non-medical switching and its implications for patients, physicians, and the long-term sustainability of biosimilar markets; a whitepaper based on the meeting will be featured in the Q1 2023 issue of GaBI Journal.

 

More information on the IRA webinars will be available in the coming weeks.

 

 

ASBM/IFA Survey: Canadian Ophthalmologists Overwhelmingly Oppose Forced Switching

 

On February 28th, ASBM and the Ontario-based International Foundation on Ageing (IFA) released the results of a new survey of Canadian ophthalmologists that documents these specialists’ views on biosimilars and substitution practices.

 

The survey’s release comes on the heels of Ontario’s recent announcement that it would begin force-switching patients with a variety of conditions from their physician-prescribed products to government-chosen biosimilars, beginning March 31st.

 

The survey of 41 Canadian ophthalmologists, all of whom prescribe biologics in their practice revealed:

  • 81% were not comfortable with a third party such as a government switching a patient’s medicine for non-medical reasons such as cost, as would occur under the Ontario plan.
  • 90% said that having sole authority, with the patient, to decide which biologic medicine to use is very important or critical.
  • 91% considered the ability to prevent a forced switch by a public or private payer very important or critical.

ASBM’s executive director, Michael Reilly, emphasized the stark contrast between Ontario’s plan and the more physician- and patient- centered substitution practices of Europe:
“The Ontario announcement cites 15 years of safe use of biosimilars in Europe as a justification for its forced-switching policy. What the success of biosimilars in European markets has actually shown is that countries need not sacrifice physician and patients’ choice to enjoy significant savings. Most European markets accomplish savings through competition between many reimbursed products, rather than forced switches. Patients and physicians in Canada deserve no less – yet they are increasingly seeing choice restricted rather than expanded. With the arrival of ophthalmic biosimilars, we see yet another group of physicians and their patients expressing concerns with unnecessary switching in pursuit of short-term savings.”

 

Seventy-eight percent of survey respondents said their patients would be best served by a European-style scenario where multiple products including innovator and biosimilars are reimbursed, with biosimilars encouraged for new patients but no automatic substitution.

 

Only 15% preferred a system similar to that of Ontario where only government-chosen biosimilars are reimbursed, new patients must be prescribed these products, and current patients are forced to switch.
Read the press release about the survey here.

 

View the full ophthalmologist survey here.

 

 

IQVIA Webinar Looks at U.S. Biosimilar Outlook 2023-2027

 

On February 28, IQVIA held a webinar entitled Biosimilars in the United States 2023-2027. The webinar featured findings from the recently-released report of the same name. Among the report’s key findings:

  • The U.S. biologics market has grown 12.5% annually on average over the last five years on an invoice-price basis, faster than non-biologics, and now comprising 46% of spending.
  • Recent biosimilars have achieved high volume shares, reaching more than 60% of the molecule’s volume within the first three years. Non-340B clinics have seen higher uptake of biosimilars than 340B clinics, likely due to reimbursement dynamics.
  • The three molecules with biosimilar launches in 2019 — bevacizumab (82%), trastuzumab (80%), and rituximab (67%) — achieved significant uptake within the first three years. It is unclear if uptake of these recent oncology biosimilars is indicative of future biosimilar uptake, however, these have gained higher market share than earlier biosimilars in the U.S. and are similar to or higher than rates of uptake in Europe.
  • Pegfilgrastim and epoetin alfa biosimilars, both launched in 2018, have seen moderate uptake achieving 37% share of molecule volume in the first three years. Pegfilgrastim biosimilar share has continued to rise slowly while epoetin alfa biosimilar share has fallen to 27% as of October 2022.
  • Infliximab has seen the lowest adoption of biosimilars, with volume share at 3% after one year and rising slowly to 13% after three years. This has shifted significantly in more recent years as biosimilars now account for 44% of infliximab volume nearly six years after biosimilar entry.

The presentation was followed by a panel discussion featuring Sameer Awsare, MD, Associate Executive Director, the Permanente Medical Group; Alex Brill, MA, CEO, Matrix Global Advisors, Luke Greenwalt, MBA VP and Lead, Market Access Center of Excellence, IQVIA; Chad Pettit, MBA, Executive Director, Marketing, Global Biosimilars Commercial Lead, Amgen; Marta Wosinska, Ph.D. Visiting Fellow, The Brookings Institution; Murray Aitken, Executive Director, IQVIA Institute for Human Data Science; and Michael Kleinrock, Research Director, IQVIA Institute for Human Data Science.

Read the full report here here. 

 

View a recording of the webinar here. 

 

 

 

FDA, FTC Release Biosimilars Report and Educational Resource

 

On February 28th, the U.S. Food and Drug Administration and the Federal Trade Commission released two documents related to biosimilars and interchangeable biosimilars – an educational resource for consumers and patients and a summary report from the 2020 public workshop titled “FDA/FTC Workshop on a Competitive Marketplace for Biosimilars.”

 

Three ASBM representatives participated in the joint FDA/FTC: Immediate Past Chair Madelaine Feldman, MD; Advisory Board Chair Schneider, FASHP FFIP and Andrew Spiegel provided comments at the meeting.

 

One presenter identified the chief barriers to biosimilar uptake as physicians (who needed educational outreach to increase their familiarity and comfort with biosimilars) and payers (whose policies can sometimes impede utilization, and need to be addressed). ASBM Advisory Board Chair Philip Schneider addressed these concerns in his remarks at the workshop:

 

Our recent survey of 579 European biologic prescribers shows high knowledge and high confidence in biosimilars. Depending on country, between 82% and 93% of prescribers considered themselves familiar or very familiar with biosimilars. Between 80% and 99% would feel comfortable prescribing a biosimilar to a new treatment-naïve patient. Between 46-76% would be comfortable switching a stable patient.

 

if the premise behind today’s proceedings is valid – that biosimilar uptake is strongly tied to physician confidence, the high physician confidence in biosimilars across the board should correlate with a consistently high uptake across the board.

 

Yet if we look at the biosimilar market shares across the six countries we surveyed, there is a wide variation among biosimilars in different product classes. For example, market share for the Epoetin biosimilar ranged from 6-84%.  There are similar ranges for other biosimilars.

 

Clearly there are other factors besides physician confidence, which is uniformly high across the countries. These factors likely include differences between each country’s payer policies, differences in the length of time a biosimilar has been on the market, the number of biosimilars in a given product class, the discount of each product relative to the originator product, and other factors.

 

Read the testimony and comments provided to the FDA/FTC by Dr. FeldmanDr. Schneider, and Mr. Spiegel.

Read the Summary Meeting Report here.
Read the FDA’s Educational Resource on Biosimilars here.

Visit www.fda.gov/biosimilars for more resources and information about biosimilars.

 

Cardinal Health Survey Examines Physician Confidence, Concerns with Biosimilars: 

 

According to a study released in February by Cardinal Health, while most providers think that biosimilars will positively impact care, few feel that the economic benefits of biosimilars to date are enough to motivate switching.

 

As reported in Medscape Medical News, the new survey of over 350 dermatologists, gastroenterologists, ophthalmologists, and rheumatologists, clinicians shared their opinions on the rapidly evolving landscape of biosimilars, detailing top concerns about prescribing these medications and how they presently use biosimilars in clinical practice.

 

Out of 103 surveyed rheumatologists, 62% said they were very comfortable prescribing biosimilars to patients, and 32% said they were somewhat comfortable. Providers said they would be most likely to prescribe a biosimilar to new patients (40%) or if biosimilars were mandated by a patient’s health plan (41%). Nearly one-third (31%) of rheumatologists said that a discount of 21%-30% from a reference product would be necessary to consider switching a patient to a biosimilar.

 

There are several reasons why a rheumatologist may be wary of switching patients to biosimilars, said Marcus Snow, MD, chair of the American College of Rheumatology’s Committee on Rheumatologic Care. “Rheumatologists will always express concern about changing medications that work well for their patients. It is not ideal to ‘force switch’ to a different product, even if it is almost identical,” he told Medscape Medical News in an email. “Also, we must remember that a patient on a biologic has failed traditional medications, which speaks to the struggle a patient must endure to get their disease under control. Fail-first situations can cause a rheumatologist to be initially resistant or hesitant to any changes.”
Read the full Medscape Medical News article here. (free signup required)

Read a Healio article breaking out the rheumatologist responses in the Cardinal survey here. 

 

 

UPCOMING EVENTS

 

Festival of Biologics 2022 USA

San Diego, CA – March 20-22, 2023

 

WHO 76th INN Consultation

Geneva, Switzerland – March 28, 2023

 

DIA Global Annual Meeting

Boston, MA – June 25-29, 2023


ASBM/IFA Survey: As Ontario Announces Forced Biosimilar Switching, Ophthalmologists Are Latest Specialty to Raise Concerns

February 28, 2023

Press Release: As Ontario Announces Forced Biosimilar Switching, Ophthalmologists Are Latest Specialty to Raise Concerns

28 February 2023

TORONTO, ONTARIO – Physicians and their patients- and not a government -should choose which biologic medicine to use, according to a new survey of Canadian ophthalmologists by the Alliance for Safe Biologic Medicines (ASBM) and the International Foundation on Ageing (IFA).

In the week before the 2022 holiday season, the Ontario government announced that beginning March 31st, it would be requiring thousands of patients to switch from their current, physician-prescribed biologic medicines to government-preferred biosimilar. While safe and effective medicines in their own right, biosimilars are not identical to their reference products, and most physicians are wary of unnecessary switching between medicines. Long available in the areas of arthritis, psoriasis, and cancer, biosimilars are now becoming available for ophthalmic conditions. Most ophthalmologists believe that in consultation with their patients they are in the best position to determine the most appropriate and effective treatment.

The survey of 41 Canadian ophthalmologists revealed that 81% were not comfortable with a third party such as a government switching a patient’s medicine for non-medical reasons such as cost, as would occur under the Ontario plan. Ninety percent of respondents said that having sole authority, with the patient, to decide which biologic medicine to use is very important or critical. And 91% considered the ability to prevent a forced switch by a public or private payer very important or critical.

“The Ontario announcement cites 15 years of safe use of biosimilars in Europe as a justification for its forced-switching policy,” says Michael Reilly, ASBM’s executive director.

“The success of biosimilars in European markets has actually shown that countries need not sacrifice physician and patients’ choice to enjoy significant savings. This is accomplished through competition between many reimbursed products, rather than forced switches. Patients and physicians in Canada deserve no less – yet they are increasingly seeing choice restricted rather than expanded. With the arrival of ophthalmic biosimilars, we see yet another group of physicians and their patients expressing concerns with unnecessary switching in pursuit of short-term savings.”

Seventy-eight percent of respondents said their patients would be best served by a European-style scenario where multiple products including innovator and biosimilars are reimbursed, with biosimilars encouraged for new patients but no automatic substitution.

Only 15% preferred a system similar to that of Ontario where only government-chosen biosimilars are reimbursed, new patients must be prescribed these products, and current patients are forced to switch.

“Data on the impact of ‘non-medical switching’ of ophthalmic medications is not available and as such it remains a point of contention with policies that have already been enacted in other provinces, such as Alberta and British Columbia, observes Dr. Jane Barratt, Secretary General of IFA. The survey’s findings are aligned with statements from the Canadian Retina Society (CRS), the Canadian Ophthalmology Society (COS) and American Academy of Ophthalmology (AAO) that call for more data, ‘given the unique immunological environment and limited tolerance for inflammation which exists with direct administration of the medication into the eye.” The CRS asks government to consider that “retinal diseases are sight threatening, and the retina has limited regenerative potential with vision loss often irreversible. As with IFA the CRS advocates that physicians in collaboration with their patients, be able to exercise their clinical judgement when determining how and when to use biosimilars and reference biologics, and that clinical practice and patient outcomes not be impacted primarily by budgetary considerations.”

Ophthalmologists are just the latest group of physicians to raise concerns with the practice of forced switching. The Canadian Association of Gastroenterology released a statement opposing the practice in 2019. Prior ASBM surveys across many specialties revealed that 83% of Canadian, 82% of European, and 69% of U.S. physicians consider it very important or critical that the physician and patient control treatment decisions, including the decision to switch to a biosimilar. 79% of Canadian, 84% of European, and 67% of U.S. physicians considered the ability to prevent a substitution similarly important.

Media Contact
For more information regarding the only International Federation on Ageing go to www.ifa.ngo or please contact Dr Jane Barrett at jbarrett@ifa.ngo or by phone on +1 226-457-7771.

About the International Federation on Ageing
The International Federation on Ageing (IFA) is an international, non-governmental organization (NGO) with a unique membership base comprising government, NGOs, academics, industry, and individuals in over 80 countries. Now over 45 years old, the IFA has become known as a leading and innovative organization that works across disciplines and sectors toward common goals that improve the lives of older people. Through the IFA’s formal relations with the World Health Organization (WHO) and general consultative status at the United Nations and its agencies, the IFA is in the position to advocate directly with member states and contribute to and inform intergovernmental dialogue.


January 2023 Newsletter

February 21, 2023

ASBM’s Feldman and Reilly Present at Treatment Choice Summit

 

On January 31st, ASBM’s Immediate Past Chair Madelaine Feldman, MD, FACR and Executive Director Michael Reilly participated in the 2023 Treatment Choice Summit, held in Washington, DC.
Dr. Feldman moderated the first panel discussion, Patient and Provider Perspectives on the Impact of Treatment Choice. The purpose of the discussion was to identify barriers to treatment choice and how these impact patients, their out-of-pocket costs, and the patient-physician relationship.
Mr. Reilly appeared on a second panel, entitled Recent Policy Initiatives to Protect Treatment Choice, which examined ways in which effective advocacy can protect treatment choice. Mr. Reilly emphasized the importance to physicians of maintaining control over treatment choice, citing ASBM’s extensive research into physician perspectives on non-medical switching:
“ASBM has surveyed physicians around the world and we have consistently seen that while they are confident in biosimilars they strongly believe that treatment decisions should be made by physicians in consultation with the patient – not by a third party for cost reasons.”
A 2021 ASBM survey of 401 U.S. physicians found that the majority (58%) are uncomfortable with a switch initiated by a third-party for non-medical reasons. 89% maintain that they, with their patients, should have sole control over treatment choices; and 67% consider it “very important” or “critical” that they are able to prevent a substitution they feel is inappropriate.
Read a whitepaper on the U.S. physician survey here. 

 

First Adalimumab Biosimilar Launches in U.S. 

 

On January 31st, the first biosimilar for adalimumab (Humira) launched in the U.S. market. Amjevita (adalimumab-atto) will launch at a 55% discount over its originator product’s Wholesale Acquisition Cost (WAC). Due to discounts and rebates, insurers seldom pay that price, however. According to Amgen, a second list price 5% below Humira’s will also be available to some payers to account for rebating and discounting practices by pharmacy benefits managers.

 

Adalimumab is approved to treat a variety of diseases: rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, Crohn’s disease, and ulcerative colitis.

 

Amjevita (adalimumab-atto) was the first adalimumab biosimilar approved by the FDA, in September 2016. Its launch represents the first of up to nine adalimumab biosimilars expected to enter the U.S. market this year.

 

Read more about the launch here. 

 

 

 

EMA Issues Q&A Document Clarifying Previous Statement on Interchangeability of EU Biosimilars

 

On January 20th, the European Medicines Agency released a Q&A document intended to provide clarity regarding its “Statement on the scientific rationale supporting interchangeability of biosimilar medicines in the EU,” published in September 2022. That joint statement from the EMA and the Heads of Medicines Agencies (HMA) declared the interchangeability of all biosimilar medicinal products approved in the EU. Since its publication, both the EMA and National Competent Authorities (NCAs) in EU Member States have received questions about the statement which the new document is intended to address.

 

For example, the Q&A document clarifies that biosimilar substitution policies, including policies any potential automatic substitution of biosimilars, remain the purview of the Member States:

 

Q3: Does the joint EMA-HMA statement on interchangeability of biosimilars mean that switching to or between biosimilars are allowed in my country?

 

A3: No, EMA does not regulate prescribing practices or issue clinical guidance; these matters fall under national remit and are issued by the relevant bodies in each Member State. The statement on interchangeability of biosimilars is a general statement on the scientific principle highlighting that biosimilars can be used interchangeably and detailing the scientific references supporting this position. The statement is meant to advise those Member States that want to allow for biosimilar prescribing, including any national decision on switching and/or (automatic) substitution. However, each Member State will decide on how this is applied in their territories, e.g. which biological medicines are available for prescribing in their country and whether automatic substitution with biosimilars is allowed at pharmacy level.

 

Read the EMA/HMA Joint Statement here.

Read the full Q&A statement here.

 

 

Cautionary Lessons for US Policymakers as Innovation, Access Jeopardized by UK Pricing Controls

 

In January, drug manufacturers Eli Lilly and AbbVie announced they have left the UK’s voluntary scheme for branded medicines pricing and access (VPAS), a long-standing agreement between the Government, NHS and medicine manufacturers designed to limit the cost of drugs for the health service. But these policies may jeopardize patients’ access to new treatments over time. As explained in the Telegraph:

 

The scheme caps the health service’s branded medicines bill, meaning that all drug manufacturers face a charge if the bill rises more than two per cent annually. The cost of that charge has risen rapidly in recent years as demand for NHS treatment has grown. As of Dec 2022, the payback rate was set at 26.5 per cent. Before the pandemic, the rate was about five per cent.

The Association of the British Pharmaceutical Industry (ABPI), the medicines trade body, said the increase puts the UK “out of step” with global competitors, with European countries such as Germany having rates of just nine per cent.

Eli Lilly, which has operated in the UK since the Forties, said that VPAS has “harmed innovation” in the UK and will turn it into a “global outlier”. Laura Steele, Eli Lilly’s president and general manager for northern Europe, said: “We simply cannot stay signed up to a scheme which has such a punishing impact on innovation.

Todd Manning, the general manager of AbbVie UK – which is currently manufacturing innovative drugs for lung cancer and inflammatory bowel disease – said that its decision to leave VPAS was not taken lightly and that the revenue clawbacks had a “demonstrable impact on our ability to operate sustainably in the UK”. He added: “Without a positive signal that the future scheme will deliver more reasonable rates, I fear it will be increasingly difficult to advocate for the UK and what I believe is our shared ambition of securing investment, jobs and, ultimately, delivering improved health outcomes for UK patients.”

Dr Richard Torbett, the chief executive at the ABPI, said “We have already seen the UK lose almost half of its global share of R&D over the past decade. For this trend to be reversed, we must develop a more internationally competitive scheme with the Government that can genuinely support the life sciences vision.”

The number of clinical trials initiated in the UK each year has fallen by more than two-fifths between 2017 and 2021. ABPI and its members said that the level will have further impacts on patients’ access to new and innovative drugs.

Read the full Telegraph article here.

 

 

Saskatchewan Patients Concerned as Forced Switching Approaches
A January 22nd article from the Canadian Broadcasting Company (CBC) details some of the concerns Saskatchewan patients have about the Province’s forced biosimilar switching policy, announced in October 2022. The deadline to switch from physician-chosen to government-chosen medicine is April 30th. From the article:

 

Both Diabetes Canada and Crohn’s and Colitis Canada have stated they disagree with the changes, saying medication switches need to be made in conversation with the patients.

 

Some residents in other provinces that made the switch have reported the new drugs not being effective, while others were concerned about the resurfacing of painful flare ups they had before being put on their current medication.

 

Arthritis patient Megan MacLeod said she is frustrated the government is focused more “on their collective wallet than what this is going to do to people who are living with these kinds of conditions.”

 

Read the CBC article here.

 

 

HHS Announces Medicare Drug Price Negotiation Plan

 

On January 11th, the U.S. Department of Health and Human Services (HHS) announced its plan for Medicare to begin to negotiate prices for drugs as part of the recently-passed Inflation Reduction Act. As USA Today reports:

  • By Sept. 1, Medicare will announce 10 retail drugs to negotiate maximum prices.
  • In 2024, the agency will bargain with drug manufacturers and publish prices by September for prices that will take effect Jan. 1, 2026.
  • Over the following two years, the federal health program will target another 30 retail and physician-administered drugs.
  • Beginning in 2029, Medicare will negotiate prices on up to 20 drugs each year.
  • Retail drugs are eligible only after they have been on the market for nine years without a competing generic version.
  • Physician-administered drugs will have 13 years before being subject to negotiation.

The Centers for Medicare and Medicaid Services (CMS) released a 2-page document providing a more detailed timeline, which may be read here. 

 

Read USA Today’s coverage of the announcement here. 

 

 

Reminder: ASBM Members Receive Free Access to OSU’s Biosimilars Course

 

The Ohio State College of Pharmacy has provided ASBM with access codes for our Members who wish to view the first four modules of the ASBM/OSU College of Pharmacy Biosimilars Course at no charge:

Biosimilars Module 1: Introduction to Biologics and Biosimilars 
Biosimilars Module 2: Substitution and Interchangeability
Biosimilars Module 3: Biologic and Biosimilar Pharmacovigilance  
Biosimilars Module 4: Physicians’ Perspectives on Biosimilars 

 

To request free access to the Biosimilars Course, please email Ray Patnaude here. Access to the three remaining modules in the series will be available in the coming weeks.

ICYMI: GaBI Journal Publishes Paper on ASBM US Physician Survey

 

In December, the Generics and Biosimilar Initiative (GaBI) published a whitepaper entitled “US prescribers’ attitudes and perceptions about biosimilars”, based on the findings from ASBM’s survey of 401 U.S. physicians fielded in late 2021. The paper was authored by ASBM’s Chairman Ralph McKibbin, MD, FACP, FACG, AGAF; and Executive Director Michael S. Reilly, Esq. The survey examines physician attitudes toward a wide variety of biosimilar policy issues including approval standards, non-medical switching, interchangeability, and reimbursement practices. While U.S. physicians were highly confident in the safety and efficacy of biosimilars, the survey revealed that maintaining control over treatment choices- including the ability to prevent substitution by a third party- was extremely important to the respondents. From the abstract:

 

Most physicians are comfortable prescribing biosimilars and comfortable switching stable patients to biosimilar products. Over half of physicians are more likely to prescribe biosimilars with interchangeable status and they are comfortable with pharmacy level substitution of these products. However, the majority want to keep the authority to prevent pharmacy level substitution if they specify so. When it came to switching patients to a biosimilar for non-medical reasons, the majority were comfortable doing this but fewer than half were comfortable with third party switching. In addition, most physicians favored a scenario where multiple products, including innovator and biosimilars are reimbursed, and biosimilars may be encouraged for new patients with no automatic substitution permitted.
The paper was published in GaBI Journal, Volume 11, Year 2022, Issue 3.

Read the full paper online here. 

 

 

 


ASBM’s Feldman and Reilly Present at Treatment Choice Summit

February 2, 2023

On January 31st, ASBM’s Immediate Past Chair Madelaine Feldman, MD, FACR and Executive Director Michael Reilly participated in the 2023 Treatment Choice Summit, held in Washington, DC.

tcs-feldman
Dr. Feldman moderated the first panel discussion, Patient and Provider Perspectives on the Impact of Treatment Choice. The purpose of the discussion was to identify barriers to treatment choice and how these impact patients, their out-of-pocket costs, and the patient-physician relationship.
tcs-reilly-closeupMr. Reilly appeared on a second panel, entitled Recent Policy Initiatives to Protect Treatment Choice, which examined ways in which effective advocacy can protect treatment choice. Mr. Reilly emphasized the importance to physicians of maintaining control over treatment choice, citing ASBM’s extensive research into physician perspectives on non-medical switching:
“ASBM has surveyed physicians around the world and we have consistently seen that while they are confident in biosimilars they strongly believe that treatment decisions should be made by physicians in consultation with the patient – not by a third party for cost reasons.”
A 2021 ASBM survey of 401 U.S. physicians found that the majority (58%) are uncomfortable with a switch initiated by a third-party for non-medical reasons. 89% maintain that they, with their patients, should have sole control over treatment choices; and 67% consider it “very important” or “critical” that they are able to prevent a substitution they feel is inappropriate.
Read a whitepaper on the U.S. physician survey here. 

Ontario Announces Forced-Substitution Policy

January 30, 2023

In December, the Ontario government announced that it would follow other Canadian provinces including British Columbia, Alberta, Quebec and require mandatory switching to biosimilars.  a mandatory switching in 2020, but implementation was delayed due to the COVID-19 pandemic. A nine-month transition period will begin March 31st. From the government’s announcement:

Ontarians receiving coverage under the ODB program for Copaxone®, Enbrel®, Humalog®, Humira®, Lantus®, NovoRapid®, Remicade®, and Rituxan®, will be required to transition to the biosimilar version by December 29, 2023. During the transition period between March 31 and December 29, 2023, patients are encouraged to discuss a transition plan with their health care provider through in-person, telephone or virtual visits. Exemptions will be considered for patients in certain clinical circumstances on a case-by-case basis in consultation with their health care provider.

 

While the Ontario announcement justifies the policy by citing 15 years of successful use of biosimilars in Europe, it is important to note that in nearly every European country physicians retain free choice between multiple reimbursed products and forced substitution is rare. A 2017 survey of 403 Canadian physicians revealed that Canadian physicians are generally opposed to forced substitution: 

  • 64% were not comfortable with a third party switching a patient’s medicine for non-medical reasons, as would occur under the Ontario policy. 28% were somewhat comfortable, and only 6% were completely comfortable.
  • 83% considered it “very important” or “critical” that the prescribing physician decide the most suitable biologic for their patients.
  • 79% considered it “very important” or “critical” to have the authority to designate on a prescription for a biologic medicine “Dispense as Written” or “Do Not Substitute”.

Read the announcement from the Ontario government here. 


ASBM Members: Get Free Access to ASBM/OSU Biosimilars Course

January 10, 2023

The Ohio State College of Pharmacy has provided ASBM with access codes for our Members who wish to view the first four modules of the ASBM/OSU College of Pharmacy Biosimilars Course at no charge:

Biosimilars Module 1: Introduction to Biologics and Biosimilars 
(Prof. Philip Schneider, MS FASHP FFIP)

Biosimilars Module 2: Substitution and Interchangeability
(Prof. Philip Schneider, MS FASHP FFIP)

Biosimilars Module 3: Biologic and Biosimilar Pharmacovigilance  
(Prof. Philip Schneider, MS FASHP FFIP)

Biosimilars Module 4: Physicians’ Perspectives on Biosimilars 
(Ralph McKibbin, MD, FACP, FACG, AGAF)

To request free access to the promotional codes for ASBM members, please contact Ray Patnaude at media@safebiologics.org
Promotional codes will be made for the remaining modules in the coming weeks.
View all available modules in the ASBM/OSU Biosimilars Course here.

ASBM Adds Module on PBM Practices to Ohio State University Biosimilars Course

January 10, 2023

In December, ASBM recorded the seventh and final module in its biosimilar Continuing Education (CE) Course on Biosimilars, presented with the Ohio State University College of Pharmacy. The latest module is entitled “PBMs and Payer Practices” and is presented by ASBM’s Immediate Past Chair Madelaine Feldman, MD, FACR.

In this module Dr. Feldman explains unique features of the U.S. drug distribution system, with an emphasis on payer and pharmaceutical benefit manager (PBM) practices regarding biologic medicines and biosimilars. The bifurcated U.S. system (provider-administered vs. self-administered/pharmacy side) is examined in detail and the differences in these two sub-markets are highlighted: in particular, the degree to which savings can be achieved, and the role played by middlemen and manufacturer rebates in driving up rather than lowering costs. Utilization management tools used by payers (including non-medical switching and step therapy) are described, as are proposed regulations and legislation to restrict such practices.

Upon completion, students will be able to:
  1. Discuss the role of pharmaceutical benefit managers (PBMs) in the U.S. drug distribution system
  2. Explain the effects of competition on drug pricing under provider-administered and patient-administered drugs.
  3. Identify several utilization management techniques used by PBMs to influence which medicine the patient receives.
  4. Describe concerns that patients and physicians have regarding these PBM practices.
  5. Discuss potential legislative approaches under consideration to address concerns with these PBM practices.

View all available modules of the ASBM/OSU Biosimilars Course here. 

 


December 2022 Newsletter

January 1, 2023

ASBM Adds Module on PBM Practices to OSU College of Pharmacy Biosimilars Course

 

In December, ASBM recorded the seventh and final module in its biosimilar Continuing Education (CE) Course on Biosimilars, presented with the Ohio State University College of Pharmacy. The latest module is entitled “PBMs and Payer Practices” and is presented by ASBM’s Immediate Past Chair Madelaine Feldman, MD, FACR.

 

In this module Dr. Feldman explains unique features of the U.S. drug distribution system, with an emphasis on payer and pharmaceutical benefit manager (PBM) practices regarding biologic medicines and biosimilars. The bifurcated U.S. system (provider-administered vs. self-administered/pharmacy side) is examined in detail and the differences in these two sub-markets are highlighted: in particular, the degree to which savings can be achieved, and the role played by middlemen and manufacturer rebates in driving up rather than lowering costs. Utilization management tools used by payers (including non-medical switching and step therapy) are described, as are proposed regulations and legislation to restrict such practices.

 

Upon completion, students will be able to:
  1. Discuss the role of pharmaceutical benefit managers (PBMs) in the U.S. drug distribution system
  2. Explain the effects of competition on drug pricing under provider-administered and patient-administered drugs.
  3. Identify several utilization management techniques used by PBMs to influence which medicine the patient receives.
  4. Describe concerns that patients and physicians have regarding these PBM practices.
  5. Discuss potential legislative approaches under consideration to address concerns with these PBM practices.

View all available modules of the ASBM/OSU Biosimilars Course here. 

 

 

Free Access to ASBM/OSU Biosimilars Course for ASBM Members

 

The Ohio State College of Pharmacy has provided ASBM with access codes for our Members who wish to view the first four modules of the ASBM/OSU College of Pharmacy Biosimilars Course at no charge:

Biosimilars Module 1: Introduction to Biologics and Biosimilars 
(Prof. Philip Schneider, MS FASHP FFIP)
Biosimilars Module 2: Substitution and Interchangeability
(Prof. Philip Schneider, MS FASHP FFIP)
Biosimilars Module 3: Biologic and Biosimilar Pharmacovigilance  
(Prof. Philip Schneider, MS FASHP FFIP)
Biosimilars Module 4: Physicians’ Perspectives on Biosimilars 
(Ralph McKibbin, MD, FACP, FACG, AGAF)

To request free access to the course, email Ray Patnaude at media@safebiologics.org.
Promotional codes will be made for the remaining modules in the coming weeks.
View all available modules in the ASBM/OSU Biosimilars Course here.
GaBI Journal Publishes Paper on ASBM US Physician Survey

 

In December, the Generics and Biosimilar Initiative (GaBI) published a whitepaper entitled “US prescribers’ attitudes and perceptions about biosimilars”, based on the findings from ASBM’s survey of 401 U.S. physicians fielded in late 2021. The paper was authored by ASBM’s Chairman Ralph McKibbin, MD, FACP, FACG, AGAF; and Executive Director Michael S. Reilly, Esq. The survey examines physician attitudes toward a wide variety of biosimilar policy issues including approval standards, non-medical switching, interchangeability, and reimbursement practices. While U.S. physicians were highly confident in the safety and efficacy of biosimilars, the survey revealed that maintaining control over treatment choices- including the ability to prevent substitution by a third party- was extremely important to the respondents. From the abstract:

 

Most physicians are comfortable prescribing biosimilars and comfortable switching stable patients to biosimilar product. Over half of physicians are more likely to prescribe biosimilars with interchangeable status and they are comfortable with pharmacy level substitution of these products. However, the majority want to keep the authority to prevent pharmacy level substitution if they specify so. When it came to switching patients to a biosimilar for non-medical reasons, the majority were comfortable doing this but fewer than half were comfortable with third party switching. In addition, most physicians favored a scenario where multiple products, including innovator and biosimilars are reimbursed, and biosimilars may be encouraged for new patients with no automatic substitution permitted.
The paper was published in GaBI Journal, Volume 11, Year 2022, Issue 3.

Read the full paper online here. 

 

 

 

 

Ontario Announces Forced-Substitution Policy

 

In December, the Ontario government announced that it would follow other Canadian provinces including British Columbia, Alberta, Quebec and require mandatory switching to biosimilars.  a mandatory switching in 2020, but implementation was delayed due to the COVID-19 pandemic. A nine-month transition period will begin March 31st. From the government’s announcement:
Ontarians receiving coverage under the ODB program for Copaxone®, Enbrel®, Humalog®, Humira®, Lantus®, NovoRapid®, Remicade®, and Rituxan®, will be required to transition to the biosimilar version by December 29, 2023. During the transition period between March 31 and December 29, 2023, patients are encouraged to discuss a transition plan with their health care provider through in-person, telephone or virtual visits. Exemptions will be considered for patients in certain clinical circumstances on a case-by-case basis in consultation with their health care provider.

 

While the Ontario announcement justifies the policy by citing 15 years of successful use of biosimilars in Europe, it is important to note that in nearly every European country physicians retain free choice between multiple reimbursed products and forced substitution is rare. A 2017 survey of 403 Canadian physicians revealed that Canadian physicians are generally opposed to forced substitution: 

  • 64% were not comfortable with a third party switching a patient’s medicine for non-medical reasons, as would occur under the Ontario policy. 28% were somewhat comfortable, and only 6% were completely comfortable.
  • 83% considered it “very important” or “critical” that the prescribing physician decide the most suitable biologic for their patients.
  • 79% considered it “very important” or “critical” to have the authority to designate on a prescription for a biologic medicine “Dispense as Written” or “Do Not Substitute”.

Read the announcement from the Ontario government here. 

 

 

FDA Approves Eighth Adalimumab Biosimilar

 

On December 13th, the US Food and Drug Administration (FDA) approved its eighth biosimilar for Humira (adalimumab): Idacio (adalimumab-aacf).

 

Idacio is a tumor necrosis factor (TNF) blocker that blocks the production of TNF-alpha to reduce inflammation in the joints and skin. Idacio is indicated to treat a range of autoimmune disorders such as ankylosing spondylitis, Crohn’s disease, juvenile idiopathic arthritis, hidradenitis suppurativa, plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, ulcerative colitis and uveitis. It is expected to launch in the US in July 2023 as self-administered prefilled syringes and self-administered prefilled pens (autoinjectors).

 

The approval brings the total number of biosimilars approved in the U.S. to forty.

 

Read more about the approval here.

 

 

UPCOMING EVENTS

 

The 2023 Treatment Choice Summit

Washington, DC – January 31, 2023

 

Festival of Biologics 2022 USA

San Diego, CA – March 20-22, 2023

 

WHO 76th INN Consultation

Geneva, Switzerland – March 28, 2023

 

 


GaBI Journal Publishes Paper on ASBM US Physician Survey

December 20, 2022

In December, the Generics and Biosimilar Initiative (GaBI) published a whitepaper entitled “US prescribers’ attitudes and perceptions about biosimilars”, based on the findings from ASBM’s survey of 401 U.S. physicians fielded in late 2021. The paper was authored by ASBM’s Chairman Ralph McKibbin, MD, FACP, FACG, AGAF; and Executive Director Michael S. Reilly, Esq. The survey examines physician attitudes toward a wide variety of biosimilar policy issues including approval standards, non-medical switching, interchangeability, and reimbursement practices. While U.S. physicians were highly confident in the safety and efficacy of biosimilars, the survey revealed that maintaining control over treatment choices- including the ability to prevent substitution by a third party- was extremely important to the respondents. From the abstract:

Most physicians are comfortable prescribing biosimilars and comfortable switching stable patients to biosimilar product. Over half of physicians are more likely to prescribe biosimilars with interchangeable status and they are comfortable with pharmacy level substitution of these products. However, the majority want to keep the authority to prevent pharmacy level substitution if they specify so. When it came to switching patients to a biosimilar for non-medical reasons, the majority were comfortable doing this but fewer than half were comfortable with third party switching. In addition, most physicians favored a scenario where multiple products, including innovator and biosimilars are reimbursed, and biosimilars may be encouraged for new patients with no automatic substitution permitted.
The paper was published in GaBI Journal, Volume 11, Year 2022, Issue 3.

Read the full paper online here. 

 


November 2022 Newsletter

December 8, 2022

ASBM Presents at Festival of Biologics 2022 Europe

 

From November 2nd-4th, ASBM representatives participated in the Festival of Biologics 2022 Europe, held in Basel, Switzerland.

ASBM Advisory Board Chair Philip Schneider, MS, FASHP, FFIP gave a presentation entitled “Key Factors for Improving Sustainability in Biosimilar Markets”. The presentation reflected the findings from a recent webinar ASBM held on this subject with GaBI Journal. Among the factors identified in the webinar were the ability for physicians to choose freely between multiple products- innovators and biosimilars- when prescribing.

Professor Schneider also presented a poster session on the topic featuring data from ASBM’s recent survey of 401 US physicians. Findings included:

  • 71% of respondents considered it highly important that payers (public and private) should reimburse multiple products in a given class- including originator and biosimilars.
  • 81% believe their patients would be best served under the biosimilar access scenario popular throughout most of Western Europe- in which biosimilars and originator products are both reimbursed, biosimilars may be encouraged for new patients, but automatic or pharmacy-level substitution is not permitted.
  • Only 8% supported the access scenario implemented by several Canadian provinces, in which only a preferred, government-chosen product is reimbursed and to which both new and stable patients must be switched. 11% were unsure.

ASBM Steering Committee Member Andrew Spiegel, Executive Director of the Global Colon Cancer Association, gave the Day 3 opening keynote address on the topic: “Protecting the future of biosimilars”. Mr. Spiegel also chaired a panel entitled “Biosimilar Communication and Patient Engagement Strategies – How Can Stakeholders Work Together to Effectively Communicate About Biosimilars in the Clinic?” on which Professor Schneider appeared as a panelist.

 

View ASBM’s recent webinar “Key Factors for Successful Biosimilar Uptake: Europe and US” here.

 

Read the GaBI Journal report of the webinar here.

 

View Professor Schneider’s Festival of Biologics presentation here.

 

View ASBM’s Festival of Biologics poster here. 

 

 

Senate Bill Would Ban Switching Studies for Interchangeable Biosimilars

 

On November 17th, Utah Sen. Mike Lee introduced S.6, the Biosimilar Red Tape Elimination Act, a bill which would prohibit the FDA requiring switching studies for biosimilars to gain interchangeability status. Under U.S. state law, only “interchangeable” biosimilars can be substituted at the pharmacy without the prescribing physician’s prior approval (although the prescriber must be informed of the substitution and may prevent substitutions.)
The new bill is aiming to increase competition within the biological drug market and reduce consumer costs by eliminating what its authors perceive as barriers to access for biosimilars. From the bill’s language:
“(B) CERTAIN STUDIES NOT REQUIRED.— The Secretary may not require, for a determination of interchangeability described in sub paragraph (A), that a biological product undergo studies that assess the risks of alternating or switching between use of the biological product and the reference product.’’
ASBM’s recent survey of 401 U.S. physicians found that a biosimilar being designated as “interchangeable” by the FDA makes a majority (57%) more comfortable prescribing it, and with pharmacy-level substitution in place of the originator (59%).
In order to receive this designation, biosimilar manufacturers must provide additional data to the FDA to demonstrate that a patient repeatedly switched between a reference product and its biosimilar can expect the same result, without any additional risks, relative to a patient who was not switched. The Lee bill would remove such data requirements.
While the term “interchangeable biosimilar” has a precise legal definition in the U.S., in September the European Medicines Agency declared all biosimilars “interchangeable” (meaning “the biosimilar can be used instead of its reference product (or vice versa) or one biosimilar can be replaced with another biosimilar of the same reference product.”)
Notably, the EMA statement does not weigh in on biosimilar substitution policy, which is left to individual member states. In nearly every European country, the automatic substitution of biosimilars in not permitted, and the choice of which product to prescribe rests with the physician.
Read about the Biosimilar Red Tape Elimination Act here. 
ASBM Chairman Named to ACG Board of Governors

 

In November, ASBM Chairman Ralph McKibbin, MD FACP FACG AGAF was named to the American College of Gastroenterology’s (ACG’s) Board of Governors. From ACG’s announcement:

 

Dr. Ralph D McKibbin has been selected to serve as a Governor of the American College of Gastroenterology. He will represent the members of Western Pennsylvania. The Board of Governors acts as a two-way conduit between College leadership and the membership at large. The ACG Governors also act as representatives on important issues facing gastroenterologists and organized medicine at large at both the national and state levels with advocacy activities occurring with Federal and State bodies as well as professional associations on regional, state and national levels.

 

A practicing gastroenterologist in Altoona, PA, Dr. McKibbin has served as ASBM Chairman since September 2021. He is past president of both the Pennsylvania Society of Gastroenterology and of the Digestive Disease National Coalition (DDNC).

 

More information about the ACG Board of Governors may be found at the ACG website here. (registration required).

 

 

 

ASBM Members Share Patient Perspectives at GRx+Biosims Conference

 

On November 9th, two ASBM Steering Committee members participated in the 2022 Generics and Biosimilars Conference (GRx+Biosims), held in Bethesda, MD. Andrew Spiegel of the Global Colon Cancer Association and Gavin Clingham of the Alliance for Patient Access both shared patient perspectives on biosimilars at a panel entitled “The Patient Voice in Drug Development”.

 

The purpose of the discussion was to hear from both the FDA and patient advocacy groups involved in this space about how the patient voice and experience can be harnessed to speed the development of and access to generics and biosimilars, and the tools that can be used to improve the patient perspective in this process.

 

Other speakers included representatives from the FDA’s Office of Generic Drugs (OGD) at the Center for Drug Evaluation and Research (CDER): Sarah Ibrahim, PhD, PharmD, Associate Director for Global Regulatory Affairs at the Office of Generic Drugs at CDER; and Partha Roy, PhD, Director of the Office of Bioequivalence at CDER.

 

The conference was sponsored by the Biosimilars Council, a division of the Association for Accessible Medicines. AAM represents the manufacturers and distributors of finished generic pharmaceuticals and biosimilars, manufacturers and distributors of bulk pharmaceutical chemicals, and suppliers of other goods and services to the generic industry.

 

Read more about the 2022 GRx+Biosims Conference here.

 

 

ASBM Submits Comments on Minnesota Health Plan Legislation

 

On November 3rd, ASBM submitted comments to the Minnesota Department of Commerce on two mandated health benefit bills, as part of a public comment period.

 

The first proposal was SF 990, mandating coverage of multiple biologic products, which ASBM opposed. ASBM had previously led patient advocacy organization opposition to the measure last summer. From the comment letter: 

It is our view that HF 1516/SF 990 while intended to promote competition and lower prices, may result in unintended negative consequences- such as actually increasing, rather than lowering, drug costs for Minnesota patients.

 

While we strongly support legislation that is written with the goal of realizing cost savings through competition between multiple biologic products, we believe that HF 1516/SF 990 undermines this objective by removing current incentives to compete on price and will ultimately reduce rather than promote affordability of biologics. For this reason, we strongly urge the Department of Commerce to oppose SF 990.

 

ASBM’s comments offered support for the second bill, HF 4899, which would mandate health plan coverage for biomarker testing: 

 

Patients with serious and chronic conditions such as cancer or rheumatoid arthritis must often try multiple treatments before finding the one that works best for them. Biomarker testing helps ensure that patients receive the right treatment for them in a timely manner.

 

But health care coverage for biomarker testing too often fails to keep pace with these scientific advancements. HF 4899 will work to remedy this by requiring health plans in Minnesota to cover biomarker testing when supported by medical and scientific evidence, including nationally-recognized clinical practice guidelines and FDA approval.

 

Timely access to appropriate biomarker testing helps achieve better health outcomes, improves quality of life for patients, and reduces costs to our health system. For these reasons, we strongly urge the Department of Commerce to support HF4899.

 

Read ASBM’s comment letter here.

 

 

 

FDA Approves Second Interchangeable Insulin

 

On November 17th, the U.S. FDA approved its second interchangeable insulin product, Rezvoglar(insulin glargine-aglr).
Manufactured by Eli LIlly, it is the second interchangeable biosimilar to Lantus (insulin glargine) and the fourth interchangeable biosimilar product overall. Interchangeable biosimilars may be substituted in all 50 states without the involvement of the prescribing physician.

 

Learn more about the approval here. 

 

 


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