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

Dec 1, 2020, 00:00
10.1016/j.jval.2020.06.014
https://www.valueinhealthjournal.com/article/S1098-3015(20)34351-5/fulltext
Title : Association Between Filgrastim Biosimilar Availability and Changes in Claim Payments and Patient Out-of-Pocket Costs for Biologic Filgrastim Products
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(20)34351-5&doi=10.1016/j.jval.2020.06.014
First page : 1599
Section Title : HEALTH POLICY ANALYSIS
Open access? : No
Section Order : 1599

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.

Categories :
  • Administrative Claims (Insurance and Billing) Data
  • Biologics & Biosimilars
  • Health Policy & Regulatory
  • Reimbursement & Access Policy
  • Specialized Treatment Areas
  • Study Approaches
Tags :
  • biosimilars
  • commercial insurance
  • Filgrastim
  • insurer payments
  • patient out-of-pocket costs
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