06 Dec Biosimilars – a novel aspect of cost containment in Health Insurance – Dr Detloff Rump

Biosimilars – a novel aspect of cost containment in Health Insurance

With the advent of personalised medicine, it became obvious that in many cases the cost of pharmaceutical therapy presents a serious challenge to health insurers – and often also to the insured individual. For instance a course of targeted treatment for cancer using biologicals (i.e. drugs that are synthesised in in living tissue/microorganisms) can easily outrun annual or per-event cover limits. That means that insurers are in for maximum pay-outs, while sometimes the insured is asked for substantial out-of-pocket payments.

Biological drugs that have been developed for a relatively small cohort of potential patients (example:  monoclonal antibodies), come almost inevitably at a higher unit cost compared to mass-produced chemical compounds. This high cost has lead to the institution of a market for alternative drugs that have similar but not identical attributes as the original reference pharmaceutical. They are commonly referred to as Biosimilars. They generally can be expected to be of comparable efficacy in an specific clinical setting.

Biosimilars are not by definition cheap drugs, but they do provide an opportunity to considerably reduce the burden of treatment cost. It is estimated that around 20 to 30% can be saved, if biosimilars are used as an alternative to the reference drug.

There are questions of course on the level of similarity required, on long term efficacy, safety aspects, availability, storage and so on. And it is probably safe to assume that commercial influence may impact the utilisation of biosimilars. Hence, the decision making process may not be straightforward in some circumstances.

In any case, it is paramount that the treating physician has clear and unbiased  information at hand when considering biosimilars, in order to make decisions in the best interest of the patient. Perhaps there is a role for Health Insurers (and their Medical Directors) to play. Obviously, this would not be about giving advice on medical matters, but teaming up with experts in order to provide reliable and uptodate information on biosimilars to clinical decision makers.