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. 2020 Dec;23(12):1599-1605.
doi: 10.1016/j.jval.2020.06.014. Epub 2020 Oct 23.

Association Between Filgrastim Biosimilar Availability and Changes in Claim Payments and Patient Out-of-Pocket Costs for Biologic Filgrastim Products

Morgane C Mouslim  1 , Antonio J Trujillo  2 , G Caleb Alexander  3 , Jodi B Segal  4
Affiliations

Association Between Filgrastim Biosimilar Availability and Changes in Claim Payments and Patient Out-of-Pocket Costs for Biologic Filgrastim Products

Morgane C Mouslim et al. Value Health. 2020 Dec.

Abstract

Objectives: To estimate the effect of filgrastim-sndz market entry on patient out-of-pocket costs and claim payments for filgrastim products.

Methods: This study used a single interrupted time series design with longitudinal, nationally representative, individual-level claims data from IBM MarketScan. Analyses included all outpatient and prescription claims for branded filgrastim (filgrastim and tbo-filgrastim) and biosimilar filgrastim (filgrastim-sndz) from January 1, 2014, to December 31, 2017. Outcomes of interest included changes in monthly claim payments and monthly patient out-of-pocket costs for filgrastim products.

Results: In the baseline period (January 2014 to February 2016), insurers paid an average of $472.21 (95% confidence interval [CI]: 465.38-479.03) for 480 mcg of branded filgrastim, whereas patients paid an average of $49.26 (CI: 34.25-64.27). Filgrastim-sndz market entry was associated with a statistically significant and immediate 1-month decrease in insurer payment of $30.77 (95% CI: -40.59 to -20.94) and a significant decrease in monthly insurer payment trend of $3.10 per month (95% CI: -3.90 to -2.31) relative to baseline. Long-term changes in patient out-of-pocket costs were modest and restricted to beneficiaries enrolled in high cost sharing plans.

Conclusions: Biosimilar filgrastim availability led to significant immediate and long-term decreases in claims payments for filgrastim products, supporting efforts to facilitate biosimilar adoption in the United States. Nevertheless, there were only slight changes in patient out-of-pocket costs, restricted to beneficiaries enrolled in high cost sharing plans, suggesting the importance of further work assessing the relationship between biosimilar availability and patient out-of-pocket costs.

Keywords: biosimilars; commercial insurance; filgrastim; insurer payments; patient out-of-pocket costs.

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Conflict of interest statement

Conflicts of Interest: Dr. Alexander reports personal fees from IQVIA, personal fees from Monument Analytics, and personal fees from OptumRx, outside the submitted work; Dr. Trujillo, Dr. Segal and Dr. Mouslim report no conflicts of interest and have nothing to disclose.

Conflict of Interest Disclosures: Dr Alexander reported receiving personal fees from IQVIA Monument Analytics, and OptumRx outside the submitted work. Dr Alexander is the past Chair of FDA’s Peripheral and Central Nervous System Advisory Committee; has served as a paid advisor to IQVIA; is a co-founding Principal and equity holder in Monument Analytics, a healthcare consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation; and is a member of OptumRx’s National P&T Committee. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies.

Figures

Fig 1.
Fig 1.
Branded versus biosimilar filgrastim utilization (2014-2017). Launch corresponds to September 2015, the month biosimilar filgrastim (filgrastim-sndz) was launched in the United States. Int. point indicates intervention point (February 2016).
Fig 2.
Fig 2.
Average monthly claims payments for branded vs biosimilar filgrastim from January 2014 to December 2017. Launch corresponds to the launch month of biosimilar filgrastim (September 2015). Average monthly claims payments are adjusted for inflation using the Medical Care Consumer Price Index and all amounts are presented in January 2014 US dollars. Int. point indicates intervention point (February 2016).
See this image and copyright information in PMC

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