Many California patients and their families struggle to afford their life-saving and life-sustaining health care. This is particularly true for those living with chronic and life-threatening conditions such as liver disease, cancer, hepatitis, arthritis, multiple sclerosis, and others for which the cost of treatment can be prohibitive.
Biosimilar medications hold the potential to increase access to affordable and effective care. However, many California patients are not yet able to realize the cost-saving benefits of biosimilars. It is time for Congress to take commonsense action to increase access to biosimilar medications and unlock their cost-savings potential for all California patients.
Biosimilars are biological products similar to U.S. Food and Drug Administration-approved drugs in safety and efficacy. Biosimilars are often lower-cost versions of the original drug.
Many biosimilars have been approved for conditions to treat autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, plaque psoriasis, and ulcerative colitis. Biosimilars are also available to treat certain types of colorectal, lung, breast, and other types of cancers.
Despite the numerous benefits of biosimilars, they often face hurdles to get to the marketplace, including misinformation about their efficacy, delays brought on by the efforts by some pharmaceutical manufacturers to extend the patent life of the original drugs, a lack of rebates given by manufacturers to insurers, and limited accessibility of biosimilars to patients. In fact, of the 24 FDA-approved biosimilars, only 11 are actually available for patients.
Another hurdle are pharmacy benefit managers, the middlemen who often determine what treatments are covered by insurance and who act as gatekeepers. They can decide not to cover cheaper biosimilar alternatives.
Biosimilars have been estimated on average to cost nearly 30 percent less than the original products and could save Americans as much as $54 billion over the next decade. The FDA estimates that last year patients could have saved more than $4.5 billion alone with access to approved biosimilars.
There are two potential policy solutions that could have an immediate impact to help patients: reducing out-of-pocket costs for biosimilars, and creating a shared-savings model with prescribers.
Making a more affordable system to increase biosimilar usage would save seniors as much as $3.3 billion in out-of-pocket costs over the next decade, with an overall saving of up to $5.2 billion in taxpayer dollars over the next 10 years.
Implementing a “shared savings” model in which the savings associated with prescribing a biosimilar would be shared with health care providers would save $3 billion in tax dollars over the next 10 years.
Patients with chronic conditions depend on the leadership of lawmakers to find solutions that would alleviate the rising cost of health care. With Congress back in session, we urge legislators to increase access to biosimilars — a potential solution that would give alternative treatment and cost options to those suffering from debilitating conditions.
Scott Suckow is chairperson of the California Chronic Care Coalition in San Diego.