“Often manufacturers offer large rebates to PBMs that keep the actual price of a reference drug to the PBM below that of the biosimilar,” Prof. Miller says by email.
Limitations of the study include the lack of information on appeals for coverage denials and on the benefit design of health plans including any co-insurance or co-payments.
“The way many drug insurance plans are structured, the biosimilar may not be cheaper for patients,” says Daniel Solomon, MD, MPH, of Brigham and Women’s Hospital and Harvard Medical School, Boston.
“The rationale is difficult to understand,” Dr. Solomon, who wasn’t involved in the study, says by email. “Patients should always shop around and get details before deciding on an insurance option.”
Several authors of the research letter reported receiving grants from or consulting for biotech or pharmaceutical companies and other organizations.
Reference
- Chambers JD, Lai RC, Margaretos NM, et al. Coverage for biosimilars vs. reference products among U.S. commercial health plans. JAMA. 2020 May 19;323(19):1972–1973.
