OBJECTIVES : Use objective data to examine the growth of specialty-drugs, biosimilar use, and coverage benefits.

METHODS : Retrospective analysis of Workpartners Research Reference Database (RRDb,2016—2020) representing ~3million employees and ~4.6million total lives from multiple US private-sector employers in the retail, service, manufacturing, transportation, energy, technology, financial, and utility industries. Annual claims/dollars for specialty-agents were classified as innovator(reference) agents or biosimilars and by benefit used (prescription/medical). Claims and costs in 2020 were compared with baseline(2016).

RESULTS : Over the five-year period, utilization of specialty-drugs cost $301.5million for 73,611 claims in aggregate (innovator&biosimilar). Compared with 2016, 2020 claims increased by 17% and dollars increased by 30%. In 2016, 94.6% of claims and 96.8% of dollars were paid under the drug-benefit for innovator products, by 2020, biosimilars reduced these numbers to 64.4% of claims and 79.2% of dollars. In 2016, 98.4% of claims and 99.8% of dollars under the medical-benefit were for innovator-products, by 2020, biosimilars reduced these numbers to 80.1% (both claims and dollars). In 2016, 5.9% of innovator product claims and 7% of dollars were processed under the pharmacy-benefit dropping to 3.3% of claims and 4.1% of dollars in 2020. Biosimilar utilization was reduced from 18% of claims and 55.4% of dollars in 2016 to 7.1% of claims and 4.3% of dollars through the pharmacy-benefit. In total, comparing 2020 with 2016, innovator-product use remained relatively constant (decreasing ~5% in claims and increasing ~4% of dollars), while biosimilars’ claims increased by 1198% of claims and 6120% of costs.

CONCLUSIONS : Health plans have recognized the value/savings and increased the use of biosimilars. The shift from the pharmacy/drug to the medical-benefit may be due to many of of these biosimilars being infused. Future analysis should focus on individual biologics (innovator/biosimilar pairs), explore whether the findings vary by therapeutic area, agent, insurance plan and by region of the country.