Vizient Survey Reveals Provider Motivations for Choosing Biosimilar Over Humira

In Vizient’s 2022 Biosimilar Survey, Vizient members found that although interchangeable biosimilars aren't abundant right now, they consider interchangeable designations to be very important in prescription decision-making, signaling the interchangeability could play a big role in the adoption of adalimumab biosimilars.

Throughout 2023, between 7 and 10 FDA-approved adalimumab biosimilars will launch in the United States, coming in different formulations, injection methods, and interchangeability statuses. According to Vizient, “the introduction of biosimilars signals the greatest opportunity for savings and value realization in this new era of biologic competition,” especially given how much stakeholders spend on Humira. In 2021, Humira generated $17.3 billion in net revenues for its developer, AbbVie.

“However, it also represents the greatest challenge to date. While the concept of biosimilars from a clinical acceptability perspective has largely been answered, the alignment between provider selection and payer coverage determination remains challenging,” wrote Vizient.

Vizient surveyed its members to assess their approach to biosimilars and evaluate the impact that formulary decisions will factor into prescription decisions at the inpatient and outpatient levels.

Interestingly, the molecules with biosimilar competition that were found to be the least likely to be included in automatic therapeutics substitution policies were ranibizumab and insulin glargine, both of which have an FDA-approved interchangeable biosimilar. Semglee (insulin glargine) is currently on the market and Cimerli (ranibizumab) was approved in early August.

However, 79% of respondents reported that they felt that interchangeability designations were very or extremely important to the biosimilar approval process despite there not being very many approved interchangeable biosimilars on the market. Vizient said in preparation for the launch of adalimumab biosimilars, it will monitor the need and function of interchangeability designations.

Epoetin and filgrastim products were the most likely to be included in substitution policies in the inpatient and outpatient settings, likely due to their “heavy health system presence.”

Likelihood of Prescribing a Biosimilar

Overall, 65% of respondents said that biosimilars would only be used for patients who were treatment-naïve, and 59% said that conversions from a reference product to a biosimilar are based upon payer demand. Additionally, 48% said they would convert patients to biosimilars over time, such as the start of a patient’s treatment cycle or when prior authorization requests need to be renewed, and 21% said they convert all patients at once, regardless of current therapy.

Generally, 51% of respondents said that their payers preferred a specific biosimilar over the reference product, 36% said any biosimilar was preferred, 21% had parity coverage of the reference product and biosimilars, and 13% had payers that preferred the originator. The influence of payers and coverage decisions was reported as a high influence on biosimilar prescribing decisions, which is expected to significantly impact the potential adoption of adalimumab biosimilars.

Biosimilars on Formularies

The majority of respondents said that they issued a formulary review for adalimumab agents, with some indicating that an approved biosimilar would be automatically added to the formulary after market entry and others saying that the decision would be left to providers, payers, or formulary designers (pharmacy benefit managers).

The researchers noted that the longer that an originator faces biosimilar competition, the more likely a biosimilar product is to be added onto formularies, but that doesn’t necessarily mean that biosimilars will have high utilization or standardization rates. Infliximab biosimilars tend to have a lower market share in relation to other biologics categories with biosimilar competition.

The report concluded, “This survey provided great insight regarding the current landscape of biosimilars and what is anticipated as we get closer to 2023…. The biosimilar adoption that has occurred to date is significant. However, Humira will represent the greatest test of the biosimilar paradigm.”