Thomas C. Blevins, MD, ECNU, FACE, FNLA, and Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, discuss the impact of interchangeable insulin biosimilars on biologic products in the marketplace for diabetes management.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: There’s some additional competition in the marketplace with similar products. I’m curious how you think this may affect things in terms of formulary and price considerations in the marketplace with insulin.
Thomas C. Blevins, MD, ECNU, FACE, FNLA: It’s interesting. The biologics are never going to be as cheap as generics because even though they’re biosimilars, they’re still very complicated. The way to make a generic—it’s not inexpensive—is you just crunch out a pill of a statin or something, apparently fairly inexpensively. That’s a generic. This is a biosimilar, and that’s different. Look at some of the pricing strategies. Let’s talk about Semglee [insulin glargine-yfgn]. Basaglar [insulin glargine] is out already as a biosimilar—it’s a follow-on biologic because it was approved under a different pathway. Now we have Semglee [insulin glargine-yfgn] out, and there are others around the world. The pricing can be quite a bit lower potentially. I’m not going to give numbers—they change all the time, and I’m not sure they’re totally accurate every time—but they’re a considerably lower cost. Then comes the complexity of the formularies. Sometimes the formularies have different pricing that they can offer, or they can get from pharmaceutical companies.
Then comes the idea of translating data into practice. Will doctors feel comfortable? In general, it’s safe to say biosimilars are less expensive, making them more affordable, making access better, which is huge in the United States and around the world too. Making a good basal insulin available, to everyone who needs it, is very important. Lots of people have diabetes, and the number of people with diabetes is not going to get smaller. It’s going to be greater everywhere. There’s a real potential for cost saving with a product that’s highly similar—so similar that the FDA says it’s interchangeable. From a practitioner standpoint, I’m pretty happy about that because every time somebody switches from 1 type of insulin to another based on formulary, even though it’s the same insulin almost—sometimes not, sometimes the rapid acting might be a little different from the other rapid acting—I have to prove it. Because the formulary says, “we prefer 1 over the other,” I have to approve it, or my staff does. It costs us a ton of time. If someone could just change it up at the pharmacy, I’ll say yes, go for the 1 that has the best price. I’m very confident that the quality is good. They’re highly similar, they’re interchangeable based on the data, and the FDA agrees. So interchangeability things a big deal.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: I totally agree. I can also commiserate with some of the challenges of when you send a prescription in for Lantus [insulin glargine] and it ends up being Basaglar [insulin glargine]. The follow-on biologic is preferred, but the pharmacist can’t make that automatic substitution. Then that requires either unnecessarily trying to submit prior authorization for Lantus [insulin glargine] or going back and forth having to change it. It does add a lot of time to everyone, but it can end up being a delay in the patient being able to get insulin, which is a huge problem. In terms of cost, it’s interesting because our cost structure for insulin is very complicated. Just because 1 product has a lower cost, doesn’t mean it’s going to be preferred by the insurance plan because there are a lot of other dynamics going on with the pharmacy benefit managers and rebates.
Each person’s insurance plan might be a little different, and some may prefer the reference product. They may prefer Lantus [insulin glargine]. In some case, they may prefer Basaglar [insulin glargine]. In some cases, they may prefer Semglee [insulin glargine-yfgn]. It’s very complicated. For sure, for someone who’s paying out of pocket, who didn’t have insurance but now has this interchangeable insurance, it will be less. I recently had to look up all these drug costs. You’re right—they change month to month. I’m updating the standards-of-care table for the ADA [American Diabetes Association], so I had to look all this up. I can tell you Semglee [insulin glargine-yfgn] is about half the price of the reference. It’s a cost savings, and we hope that will translate to everyone—to patient insurance plans, health systems, and across the board. That would be great.
Transcript Edited for Clarity