HMO and EPO insurance plans are more likely to promote the use of biosimilars

This article originally appeared on HCPLive®.

Patients with low-flexibility plans, such as exclusive provider organizations (EPOs) and health maintenance organizations (HMOs), were more likely to include patients who started biosimilars or switched to biosimilars, according to the study. published in PharmacoEconomics – Open.1:

“Understanding the full range of effects of health plan type on the use of biologics and biologics is important for policymakers and health care stakeholders as they work to increase biologic use for biologic therapy and reduce drug costs,” wrote the research team in Jeremy. Led by Costin. MHS, affiliated with the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.

Compared with patients on high deductible plans, patients on high flexibility plans were less likely to switch and/or initiate biosimilar treatment.

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Although biosimilars can reduce drug costs for biologic treatments, most biosimilars available in the United States do not have an interchangeable name and cannot be substituted for the reference drug without a new prescription. Therefore, the adoption of biosimilars is largely at the discretion of the physician, as well as the inclusion of biosimilars in health insurance plans.2:

The researchers analyzed the role of health insurance plans among commercially insured patients in the US using IBM MarketScan Commercial Claims and Encounters (CCAE) data from 2015 to 2019. Switches and biosimilar initiators were evaluated for 6 biologic-biologic pairs.

They hypothesized that plans with different levels of flexibility may exhibit different biosimilar coverage, taking into account costs, provider networks, and formulary design. Ordinal regression models and linear probability models controlling for patient demographics and drug group were used to assess this association.

The results showed that the type of health plan strongly influenced the likelihood of biosimilar uptake. Specifically, plans with lower flexibility are more likely to have biosimilar or biosimilar patients. Compared to high deductible plans, patients on a high flexibility plan were less likely to switch and/or start biosimilar treatment.

Compared to patients with high-deductible plans, the odds of being a switch were 1% higher for those with low-deductibility plans (P: <.01). In addition, they were 2% more likely to be proactive (P: <.01). These results represent a 33% increase in the likelihood of switching to a biosimilar in this type of health plan.

Conversely, enrolling in a highly flexible plan was associated with a 0.9% lower likelihood of switching (P: <.01) and a 1% lower probability of being proactive (P: <. 01) compared to high deductible plans. Therefore, low flexibility insurance plans may be a more effective strategy to encourage the adoption of biosimilars.

The investigators noted that the study was limited by its evaluation of pharmacy claims data, which included only drug data collected through pharmacy benefits. Therefore, future studies should focus on biologics and biologics prescribed in the outpatient setting to better understand factors driving product choice. In addition, the study was unable to fully examine why different types of plans reported different rates of biosimilar adoption because the database did not provide information on rebates.

“As biosimilars gain acceptance for interchangeability, promoting biosimilar adoption remains a political challenge for policymakers and researchers,” the investigators concluded. “In this context, it may be worth examining the practices of HMOs and EPOs that appear to be associated with increased biosimilar incorporation and commissioning. Such research can provide insight into the factors that influence the uptake of biosimilars and help identify strategies to further promote their use.”


  1. Costin J, Muslim MC, Social MP, Trujillo A. Examining the impact of health insurance plans on biosimilar adoption rates [published online ahead of print, 2023 Nov 3]. Pharmacoecon Open:. 2023;10.1007/s41669-023-00447-6. doi:10.1007/s41669-023-00447-6
  2. Teeple A, Ginsburg S, Howard L, et al. Patient Attitudes Regarding Switching to Non-Medical Biosimilars. Results of an online patient survey in the United States. Curr Med Res Opin. 2019; 35 (4). 603–9. doi:10.1080/03007995.2018.1560221.

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