Underwater Biosimilars Coalition: Input Requested Survey

Please take 3-5 minutes to complete our survey. Thank you!

Note: Biosimilars have been introduced to the market with the aim of reducing the prices of original (reference) biologic products. These medications are crucial for treating patients with chronic diseases like cancer, arthritis, and macular degeneration.

However, some manufacturers of provider-administered biosimilars have increased their price concessions (rebates) to insurers and Pharmacy Benefit Managers (PBMs) in exchange for preferred placement on formularies. This has led to a significant drop in the Average Sales Price (ASP). As a result, providers' acquisition costs for these biosimilars are now much higher than the reimbursements from Medicare and private health plans, making these biosimilars "unaffordable." In many cases, insurers have formularies that require patients to "fail first" with these unaffordable biosimilars.

This issue has worsened over the last 2-3 years, putting providers in a difficult position. The Underwater Biosimilars Coalition, consisting of nearly 50 provider and patient groups, is working to address this "underwater" reimbursement for provider-administered biosimilars. To strengthen its advocacy for adequate reimbursement of all biosimilars, please take the following survey on how this issue affects your ability to provide high-quality care to your patients.

1.Do you buy and bill provider-administered drugs?

Yes

2.Are there biosimilars on which you are underwater (being reimbursed less than the cost of acquisition) for administering? If so, which biosimilars? And approximately what percentage are you underwater for that drug?

3.What are some of the problems that have occurred for your patients resulting from payer mandates that have required you to administer underwater biosimilars to them?

Delay in treatment

Loss of access to care

Change in site of care

Other (please specify)

4.In instances where you must administer to a patient a biosimilar on which you are underwater, indicate as many of these scenarios that take place:

You administer the drug at a loss.

You transfer the infusion to another infusion practice.

You transfer the infusion to a hospital setting.

You switch the patient’s treatment to another drug.

You acquire the drug through a specialty pharmacy.

Other (please specify)

5.How often are you mandated to use (fail first) by the insurance company a biosimilar for which you are underwater?

Always

Most of the time

Sometimes

Rarely/never