IQVIA Makes Clear Where the Blame Should Fall for the Broken Humira Biosims Market

An early hockey game means a late-arriving Curve today. There will be more to talk about tomorrow, so I’ll leave the breaking news -- some of which feels like smoke and mirrors -- for later.

Anyone who cares about the state of the U.S. biosimilars market needs to stop what they’re doing and read this IQVIA report -- commissioned by the Biosimilars Council/AAM -- about Humira biosimilars. 

It paints a pretty damning picture of things, suggesting that even if biosimilars have forced AbbVie to make pricing concessions, the savings would be much, much greater -- particularly for patients -- if there was a concerted effort to drive biosimilars prescriptions. 

So why hasn’t there been a concerted effort? Here, IQVIA has pretty convincingly fingered a culprit: “Big Three” PBMs that stand to profit off of the rebates associated with the brand-name product. The conclusion here was pretty blunt: “Switching all adalimumab patients to biosimilars would save up to $6B for the U.S. health system. However, PBMs would lose up to 84% of profit, explaining limited uptake to date at the largest payers.”

It’s by no means news that the big PBMs are incentivized to go with high-priced, high-rebate products. I mean, that’s just business nowadays. But the IQVIA report does a great job of showing the way that smaller PBMs, who aren’t beholden to the rebate model, are driving adoption, comparing biosimilar adoption by PBM type. 

The overall stats are pretty sad: while historical trends suggest that generics and other biosimilars would have usually gained some meaningful share by this point in the biosim life cycle, the IQVIA report found, consistent with other estimates, that the Humira-biosimilars market share remains around 1%. 

I’m hoping that every health policy reporter out there takes a look at this and asks the PBMs what’s up. That would really make me happy.

USC’s Dana Goldman and  Alison Sexton Ward have a killer new STAT First Opinion piece that starts thusly: 

Not surprisingly, the whole thing is worth the read. I posted about this on LinkedIn earlier today, and that’s generating an interesting discussion. 

Elsewhere: 

• I think support for price controls on prescription drugs is a defensible position. I happen to believe that it’s the wrong position, but there’s no question that there’s an argument to be made for coercive government price-setting. Unfortunately, when we dress up price controls as “negotiations,” we obscure the real discussion we ought to be having. Anyway: thinking about this today because a whole lot of media outlets are talking about how the manufacturers’ “counteroffers” were “rejected” by CMS. I mean, c’mon. This isn’t a negotiation, and I wish we could own up to that reality. 

• A bunch of Senators asked for input on the 340B program, and the responses to that call for info are beginning to be made public. Here’s where you can get hot takes from: the Community Oncology Alliance, the National Association of Community Health Centers, the Association of American Medical Colleges, and the American Hospital Association. I’ll flag more as I see ‘em.