Biosimilar Policies and Their Impact on Market Penetration of Adalimumab, Etanercept and Infliximab: A Policy Synthesis and Descriptive Analysis in 13 OECD Countries.

backgroundDifferent biosimilar-promoting policies have been implemented worldwide to improve biosimilar uptake and reduce expenditures on costly biologics.

objectiveThe aim was to review biosimilar-promoting policies in 13 countries, and examine biosimilar uptake and expenditure reduction for adalimumab, etanercept, and infliximab, among countries with different biosimilar-promoting policies.

methodsQuarterly IQVIA MIDAS sales data from 2012 to 2023 for the three originators and their biosimilars in 13 countries were used. Two countries for a given setting (retail or hospital) and originator were paired if they differed only on one specific policy. Biosimilar uptake and relative expenditure reduction were compared between pairs. Biosimilar uptake was calculated by dividing the sales volume of biosimilars by the total sales volume of biosimilars and their corresponding originator. Expenditure reduction was the difference between the actual expenditure in 2023 and the but-for-biosimilar expenditure (based on the price of the originator in the year before biosimilar launch).

resultsBiosimilar uptake and relative expenditure reduction have grown over time across the three originators in all country-settings. We identified ten country-setting-anti-tumor necrosis factor (anti-TNF) pairs for three policies: tendering, price link, and quotas. All three policies appeared to facilitate greater biosimilar uptake, but this did not consistently translate to greater expenditure reductions. Tendering facilitated greater reductions in three out of four paired comparisons in the retail setting and zero of two comparisons in the hospital setting. Price link with low discount rates (- 20 to - 25% of originator price) and prescribing quotas facilitated greater reductions in one of three comparisons and zero of one comparison in the hospital setting, respectively.

conclusionsProcurement of biosimilars through tendering could potentially reduce spending on anti-TNFs in the retail setting, whereas price links at low discounts did not appear to help. The impact of prescribing quotas needs to be further investigated.