The ISSUE of Patient CO-Pay and Biosimilars in JPN: Is IT Really an ISSUE?
Author(s)
Rafique-Aldawery M1, Park S2, Yang E3
1CBPartners, London, KHL, UK, 2CBPartners, New York, NY, USA, 3CBPartners, San Francisco, CA, USA
OBJECTIVES : To deep dive into whether the current co-pay system in JPN actually leads to a misalignment in incentives for using biosimilars vs. originators. METHODS In-depth analysis of recent biosimilar launches, biosimilar-relevant regulatory policies, published peer-reviewed literature and local industry insights on the co-pay differences between biosimilars and their originators have been systematically reviewed. Calculations were conducted using the co-pay amounts for available biosimilars vs. originators, including the co-pay maximum rules. In addition, interviews with providers with biosimilar experience were conducted for validation and completeness. RESULTS : Currently in Japan, a cap on the co-pay patients pay per month varies by age and income and is lowered when it has been reached 3 time within a year. Patients taking HUMIRA pay an average of ¥26,700 per month over a two-year period vs. Patients on a LUCENTIS biosimilar or EYLEA biosimilar will not reach their co-pay cap at all vs. within 3 months for their originators. This would result in the LUCENTIS originator being ~33% cheaper and the EYLEA originator being ~24% cheaper than their biosimilars (after month 4) in terms of patients’ out-of-pocket medical expenses. However, in practice, providers noted paying little attention to the co-pay monthly maximum, as auxiliary medical spending (e.g., imaging and photodynamic therapy in ophthalmology patients) could bring patients over the cap. CONCLUSIONS : The high-cost medical expense benefit system is unlikely to be a barrier for the uptake of new ophthalmology biosimilars, contrary to previous biosimilars, showing a positive trend in aligning biosimilar incentives vs. originators.
Conference/Value in Health Info
2020-09, ISPOR Asia Pacific 2020, Seoul, South Korea
Value in Health Regional, Volume 22S (September 2020)
Code
PBI4
Topic
Economic Evaluation, Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
Multiple Diseases