Switch to adalimumab biosimilars in Denmark cut costs markedly

Last Updated: 2020-03-31

By Will Boggs MD

NEW YORK (Reuters Health) - The switch from brand-name adalimumab to biosimilars resulted in substantial cost reductions in Denmark, researchers report.

"In general, we believe biosimilars are 'new' generics, meaning that switching leads to price savings without affecting the treatment," Dr. Thomas Bo Jensen of Copenhagen University Hospital Bispebjerg told Reuters Health by email. "The savings can then be used to obtain better and more healthcare for other patients."

Five adalimumab biosimilars have been approved by the U.S. Food and Drug Administration, but none are marketed in the U.S. because of patent disputes. In Denmark, the Danish Medicines Council recommended switching to adalimumab biosimilars following the patent expiration of the adalimumab originator.

Dr. Jensen and colleagues evaluated the nationwide shift to adalimumab biosimilars across all indications in Denmark and calculated the actual associated cost reductions.

After the switch in October 2018, the proportion of adalimumab biosimilars increased from 71.6% in November 2018 to 95.1% in December 2018.

The costs of adalimumab decreased by 82.8% from September 2018 (8,197 pens at $5.13 million) to December 2018 (9,438 pens at $1.01 million), the researchers report in JAMA Internal Medicine.

In December 2018, the proportion of biosimilars was 77.9% for pediatrics, 94.7% for adults in Western Denmark and 97.7% for adults in Eastern Denmark.

There has been low uptake in the U.S. of biosimilars, the authors note, because there is no automated substitution for brand-name products, biosimilars are often not included in formularies, and manufacturers withdraw substantial brand-name drug discounts if payers use biosimilars. Originator adalimumab had a net revenue of $3.9 billion in the U.S. in the third quarter of 2019, they say.

"We hope that this study will be an eye-opener for physicians globally to see the economic potential of biosimilars," Dr. Jensen said. "We don't expect the U.S. to switch to biosimilars over night, but we hope our research will inspire and contribute to the ongoing discussions among patients, physicians, payers, and especially policy makers."

"In Denmark, we have seen a general shift in perception among doctors as well as patients towards being open to use of biosimilars," he said. "Biosimilars are now widely accepted like generic drugs. We hope this will be a global trend, in order to get better and more healthcare for the same money in each healthcare system."

Dr. Jensen added, "Physicians should be able to request the originator for a specific patient if there are special circumstances."

Dr. Stanley B. Cohen of Metroplex Clinical Research Center, in Dallas, Texas, who has participated in several adalimumab originator-versus-biosimilar studies, told Reuters Health by email, "Clearly utilization of biosimilars can save money in countries where the government manages health delivery. I am very skeptical that we will see substantial cost savings over and above 15-30% in the United States with the complicated and opaque system we have for purchase of medications. There will be some cost saving because of competition, but not 80%."

"Any country where the government controls the purchase of medication I think this experience will be replicated," said Dr. Cohen, who was not involved in the study. "In countries where this is not the case, cost savings will be much less. I understand significant cost savings has occurred in the U.K. as well as the Norway and not as significantly in other EU countries or Far East countries."

AbbVie declined to comment on the findings.

SOURCE: https://bit.ly/2w47vQG JAMA Internal Medicine, online March 30, 2020.