Cigna offering a $500 incentive for those who switch to a biosimilar drug

Photo: Shana Novak/Getty Images

Cigna is kick-starting a new program that offers a $500 incentive for eligible members to switch to biosimilar drugs, the health insurer said this week.

Dubbed the Innovative Shared Savings Program, the idea is to offer members a one-time $500 debit card for health services or medications as an incentive to switch to a biosimilar, and will first be made eligible to patients taking a brand-name biologic called Remicade, which treats inflammatory conditions such as psoriasis and Crohn's disease.

Remicade, according to Cigna, saw $4.2 billion in global sales in 2020, but the cost of infusion 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, which can lead to a financial challenge for patients.

Beginning in July, two approved biosimilars for Remicade, Avsola and Inflectra, will move to preferred status.

WHAT'S THE IMPACT

Biologic medicines often are priced in such a way as to cause financial challenges for both patients and health plans. Despite representing just 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, according to Evernorth. In 2019, biologics accounted for 43% of the total invoice-level medicine spending in the U.S.

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 Food and Drug Administration, though uptake has been slow.

The program's goal, said Cigna, is to drive awareness and support access to biosimilar medications, and the insurer lauded the Supreme Court's recent decision to uphold the federal framework to review and approve new biosimilars under the Affordable Care Act.

The program is intended to encourage conversations about the availability of alternative treatment options as well as any associated out-of-pocket costs. Patients eligible for the $500 debit card will receive communications from Cigna in the coming weeks detailing the program.

THE LARGER TREND

Biosimilars have the opportunity to bring significant savings to state Medicaid programs and consumers with commercial insurance, giving them a leg up over their chemical-based counterparts, according to a 2019 study from the Pacific Research Institute. Every state in the country would see significant savings in its Medicaid programs by expanding the use of biosimilars as opposed to the more expensive originator biologics.

Biosimilars currently save the healthcare system more than $240.4 million. Of these savings, 19.8% -- or $47.5 million -- is being realized by state Medicaid programs and 56.9% ($136.8 million) is being realized by the commercial market. 

But greater use of biosimilars could create significantly more savings. If biosimilars obtained a 75% market share, less than the share of these medicines in many European Union nations, the resulting annual savings for the U.S. healthcare system could be nearly $7 billion.

A separate analysis from RAND Corp. found biosimilars could cut healthcare spending in the U.S. by $54 billion over the next decade.

Cigna beat financial expectations during the first quarter of 2021 with a $1.2 billion profit and has adjusted its 2021 outlook to reflect renewed optimism, despite the difficulties created by the ongoing COVID-19 pandemic.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com