Presentation (CTI)

OBJECTIVES: Biosimilar uptake in the US has lagged other countries. One potential barrier to adoption is health plan’s use of step therapy to steer patients toward “preferred products”. This analysis examined changes over time in payer preferences for originator biologics and biosimilars.
METHODS: We used the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) Database to identify coverage policies for 10 originators and 38 biosimilars with at least 13 policies issued by 17 large US commercial payers between August 2017 and 2024. We categorized policies by whether a product was designated as first line, either as the sole preferred product or among a group of preferred products.
RESULTS: Our sample included 13,667 originator and biosimilar coverage policies. In 2017, most payers (10/17; 59%) designated an originator as the sole preferred product, 4/17 (24%) required a step through one or more biosimilars, and 4/17 (24%) covered originators on the same line as at least one biosimilar in more than 50% of policies. By 2024, fewer payers (3/18; 17%) designated an originator as the sole preferred product, while 12/18 (67%) required a step through one or more biosimilars, and 5/18 (28%) covered originators on the same line as at least one biosimilar in more than 50% of policies. Overall, the proportion of policies preferring originators declined from 84% in 2017 to 47% in 2024. Preferences varied by product family: six originators remained preferred in more than 50% of policies, while the remainder were preferred in fewer than 15%.
CONCLUSIONS: As biosimilar competition has grown, payer coverage has shifted towards biosimilars, with greater use of biosimilar-first step therapy and, in some cases, parity between originators and biosimilars. However, coverage patterns vary substantially by family and payer. Further research examining the relationship among prices, utilization, and coverage may provide insights into future trends.