Imagine being faced with the untenable choice between putting food on the table and roof over your head or access to medications that keep you healthy.
Sadly, such choices are a reality for many patients suffering with incurable diseases and medical conditions. Many senior citizens and others living on fixed incomes face high out-of-pocket costs for the medications they depend upon. Often they must choose between daily necessities or the proper dosages of medications meant to keep them healthy and independent. Foregoing the latter can be a very dangerous proposition — often resulting in a trip to the emergency room or worse.
However, biosimilars are proving to be a safe and cost-effective way to reduce costs for patients who suffer from a variety of chronic conditions. The RAND Corporation projects that biosimilars could save our health care system upwards of $54 billion over the next decade.
So, what are biosimilars? They’re essentially generic versions of medical treatment derived from biologics.
Biologics are used to treat patients suffering from a wide range of things like cancer, kidney and autoimmune diseases, rheumatoid arthritis and lupus. Biologics are also the largest cost-driver of drug spending in the Medicare system.
While biosimilars can provide similar cost savings to generic drugs, they differ in that they are not chemically-derived small-molecule drugs.
Biosimilars provide patients a lower cost alternative. There is no clinically meaningful difference between biologics and biosimilars in purity, potency or safety.
Additionally, they are reviewed and approved by the Food and Drug Administration. The FDA approved its first biosimilar in 2015 and, thus far, has deemed well over a dozen biosimilars as safe and “interchangeable” with brand-name treatments.
Unfortunately, barriers exist to widespread adoption.
Many insurers and pharmacy benefit managers are choosing to leave patients on higher-cost biologics rather than provide them lower-cost treatments offered through biosimilars — robbing patients of access to lower-cost options that have been proven safe and effective.
Unlocking savings for patients and taxpayers will require proactive reforms that incentivize greater use of biosimilars. The first of which is reducing the cost of biosimilars for patients enrolled in Medicare Part D plans by providing them lower-cost options. Research conducted by Avalere Health — a leading health care consulting firm — estimated that reduced out-of-pocket costs for patients would actually save taxpayers up to $5.2 billion over the coming decade. More importantly, it will also save seniors as much of $3.3 billion in out-of-pocket costs.
Congress also needs to curb the anti-competitive behavior that limits treatment options and allow physicians — when medically appropriate — to help patients save money. Specifically, Congress should enact legislation that provides physicians the flexibility and incentive to prescribe biologics by allowing providers to share in the cost savings and/or receive higher reimbursement rates for saving patients and taxpayers money.
It’s time for Congress to provide patients with relief from choosing between food and medications. By adopting these reforms, they can secure cost savings for patients and provide them access to the life-saving biosimilars.
Matt DeGooyer is the regional director of the Oregon and Washington Lupus Foundation of America.
