By: Dr. Steve Miller, chief clinical officer, Cigna
Biologic medicines represent a consistent challenge in the U.S. health care system today: The life-changing impact of these specialty medications comes at an ultra-high price that can be financially devastating for patients and health plans. Despite only representing 2% of prescriptions, specialty medicines accounted for more than half of the total pharmacy spend last year, driven largely by biologic medicines for inflammatory conditions and new treatments for cancer and rare diseases. In 2019, biologics accounted for 43% of the total invoice-level medicine spending [PDF] in the United States.
The health care system cannot afford the status quo.
Biosimilars are clinically equivalent alternatives to these biologics. They are produced in the same dose, at the same strength, and administered in exactly the same manner as their reference biologic drugs. There are nearly 30 biosimilars that have already been approved by the United States Food & Drug Administration (FDA), and they represent a meaningful opportunity to increase market competition and reduce drug spending by an estimated $225 billion to $375 billion over the next decade. Yet, uptake of these more affordable options has been far too slow. New solutions are needed now to drive greater awareness and support patient access to these medicines.
Cigna has been a long-time advocate for greater biosimilar adoption as part of our commitment to creating affordable access to health care in a way that is simple and predictable. We applaud the Supreme Court’s recent decision to uphold the federal framework to review and approve new biosimilars under the Affordable Care Act, but there is always more work to be done. That is why we have launched a two-part effort to promote biosimilar use and reduce prescription drug costs for customers and clients.
Driving down costs for inflammatory conditions
Over the past several years, brand-name biologic treatments for inflammatory conditions have been among the greatest contributors to drug trend growth. Remicade, a brand name medication used to treat conditions like Crohn’s disease, rheumatoid arthritis, psoriasis, psoriatic arthritis and ulcerative colitis, achieved $4.2 billion in global sales in 2020. The cost of Remicade infusions varies based on patient, indication and site of care. Based on Cigna claims data, an average regimen costs $30,000 annually, but may be much higher depending on site of administration. While life-saving and life-changing, this presents a significant challenge for health plans and can be financially devastating for patients.
Beginning in July, two approved biosimilars for Remicade, Avsola and Inflectra, will move to preferred status. With these updates, Cigna is taking concrete steps to help patients and plans realize the promise of alternative, clinically effective treatment options.
A down payment for patients on future savings: Introducing the Shared Savings Program
We believe that patients should be among the first to benefit from the realized cost savings of biosimilars. That is why Cigna will offer all eligible customers the option to receive a one-time $500 debit card for health care services and products if they decide to switch to a biosimilar or another preferred medication. These customers and their providers will receive communications from Cigna in the coming weeks detailing the program, and are encouraged to engage with their provider to determine the best treatment option.
Now is the time to advance greater adoption of biosimilars by sharing prescription drug savings directly with customers. The Shared Savings Program serves as down payment on the future promise of biosimilars. At a time when many people are having to make difficult decisions related to how to afford their medications, this program will offer some direct financial relief and position customers and their employers to recognize greater long-term cost savings.
Supporting shared decision making
Cigna understands and supports the value of the provider-patient relationship in determining the best treatment regimen, particularly for complex and chronic inflammatory conditions. This program is intended to encourage conversations about the availability of alternative treatment options, associated out-of-pocket costs, and most importantly, the patient’s health and wellbeing.
At its core, the Shared Savings Program is meant to empower patients with the information they need to engage in shared decision making with their providers. By taking part in this new program, patients have the opportunity to actively transform the health care landscape for future patients living with chronic diseases.
Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna representative.
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