Table 2.
Coverage decision characteristics
| Characteristics | Total, no. (%) | Biosimilar has no more restrictions than biologic, no. (%) | Biosimilar has more restrictions, no. (%) | p values |
|---|---|---|---|---|
| N | 1,181 | 952 | 229 | – |
| Cancer treatment | 660 (55.9) | 625 (65.7) | 35 (15.3) | < 0.001 |
| Pediatric population | 192 (16.3) | 129 (13.6) | 63 (27.1) | < 0.001 |
| FDA line of therapy | < 0.001 | |||
| 1 | 968 (82.0) | 838 (88.0) | 130 (56.8) | |
| 2 | 213 (18.0) | 114 (12.0) | 99 (43.2) | |
| First biosimilar | 531 (45.0) | 480 (50.4) | 51 (22.3) | < 0.001 |
| Years since market launch, mean (SD) | 2.5 (1.5) | 2.5 (1.5) | 2.6 (1.6) | 0.362 |
| No. of competitors | < 0.001 | |||
| 1 | 13 (1.1) | 10 (1.1) | 3 (1.3) | |
| 2 | 364 (30.8) | 361 (37.9) | 3 (1.3) | |
| 3+ | 804 (68.1) | 581 (61.0) | 223 (97.4) | |
| Disease prevalence | 0.009 | |||
| < 200,000 | 242 (20.5) | 212 (22.3) | 30 (13.1) | |
| 200,000–1,000,000 | 243 (20.6) | 191 (20.1) | 52 (22.7) | |
| > 1,000,000 | 696 (58.9) | 549 (57.7) | 147 (64.2) | |
| Annual savings per patient | < 0.001 | |||
| < $5,000 | 293 (24.8) | 258 (27.1) | 35 (15.3) | |
| $5,000–$9,999 | 350 (29.6) | 294 (30.9) | 56 (24.5) | |
| $10,000–$14,999 | 302 (25.6) | 220 (23.1) | 82 (35.8) | |
| > $15,000 | 236 (20.0) | 180 (18.9) | 56 (24.5) | |
| Coverage of the reference products related to FDA label | < 0.001 | |||
| Not more restrictive | 334 (28.3) | 208 (21.9) | 126 (55.0) | |
| More restrictive | 847 (71.7) | 744 (78.2) | 103 (45.0) | |
| Cost-effectiveness measure availability of the reference product | 0.549 | |||
| Available | 930 (78.8) | 753 (79.1) | 177 (77.3) | |
| Not available | 251 (21.3) | 199 (20.9) | 52 (22.7) | |
| Plan size | 0.932 | |||
| National | 487 (41.2) | 392 (41.2) | 95 (41.5) | |
| Regional | 694 (58.8) | 560 (58.8) | 134 (58.5) | |
| Pharmacy benefit manager | 0.048 | |||
| Big Threea | 559 (47.3) | 464 (48.7) | 95 (41.5) | |
| Others | 622 (52.7) | 488 (51.3) | 134 (58.5) |
Percentages may not add up to 100% due to rounding. T tests and chi-square tests assessed the difference in characteristics by coverage decisions
aBig Three included CVS Caremark, Express Scripts, and OptumRx