Source: United States House of Representatives – Congresswoman Carol Miller (R-WV)
Washington, D.C. – Today, Congresswoman Carol Miller (R-WV) participated in a Ways and Means Health Subcommittee hearing to discuss how biosimilars are safe, effective, and affordable options for patients who need complex pharmaceutical products and examine the challenges and opportunities to increase patient access to these alternatives.
Click here to watch the remarks.
Congresswoman Miller began by highlighting how biosimilars could help reduce health care costs for West Virginians.
“The majority of my work in the health care space is focused on ensuring robust patient access to care, particularly for rural patients. In my district, the median household income is $52,742 – which makes my district one of the most financially-constrained in the country. Additionally, 1.2 million people in West Virginia have at least one chronic disease. In a state of only 1.7 million people, that means that most West Virginians are on a tight budget already – and then also have to consider the potential high cost of managing their health. Biosimilars seem to be a great option that can help reduce patient costs, but it appears from your testimonies that we have some work to do to make sure patients and providers are educated on biosimilar options, and insurers are putting these drugs onto their formularies.”
Congresswoman Miller asked Dr. Debra Patt, MD, President, Community Oncology Alliance, about the increase in exposure to biosimilars.
“The medical community is well versed in comparison to a decade ago regarding biosimilars and I’d mentioned earlier, but I think that conversation has gotten a lot easier. Though, there are other barriers that that we face. For example, if I have a patient that’s on Trastuzumab or Herceptin to treat metastatic breast cancer, and I talk to them about switching to a biosimilar product, the insurance company and the pharmacy benefit manager will prioritize a specific biosimilar that we’re underwater on, meaning that our costs exceed our reimbursement. That doesn’t we’re not able to pick that choice because of viability. So yes, I think there’s a role in education, but there are other barriers that I think lead to suboptimal utilization. Between the patient and the insurance company, there needs to be better communication,” said Dr. Patt.
Congresswoman Miller asked Dr. Colin Edgerton, MD, Director, Articularis Healthcare Group, what are the most common questions patients ask when considering switching to a biosimilar.
“Typically, patients are most interested in the potential side effects of the drug. There can be consternation if they’re on one particular agent and they’re considering switching, or their insurance plan is maintaining a switch. So those are generally the topics of conversation when it comes to price. I don’t think there’s the understanding of how access can improve as these costs come down, and that is something I enjoy, opening that conversation with them and explaining that. But as we’ve said, a lot of that opportunity has been squandered because the formulary construction is not allowing patients access to the biosimilars, and when the Biosimilars are favored on a formulary, the economics now are upside down, because, as Dr. Pratt had mentioned, with Back Door rebates, moving from the manufacturer to the pharmacy benefit manager, now the cost of the drug is actually higher than the reimbursement,” said Dr. Edgerton.
Congresswoman Miller highlighted how in the Inflation Reduction Act complicated biosimilar development and asked Craig Burton, Executive Director, Biosimilars Council, how consistent lawmaking will improve the biosimilar marketplace.
“For biosimilar manufacture, if you’re thinking about investing $300 million in a new in a new, lower cost product, you need predictability. You need to know that that market is going to be there 10 years from now, when you get to the end of that race. That means you need to know what you need to be able to guess what the market size is going to look like. It also means you need to know you’re going to get adoption. So not only do biosimilars face all the issues we’ve discussed today, but the IRA puts in place what I think was a well-intended approach that will harm biosimilar adoption,” said Mr. Burton.