Primer: US Payers and Biosimilar Formulary Placement


Biosimilar, Follow-on Biologic (FoB), Follow-on protein product – whatever name you know them by you can’t surf the web, attend a conference, or read an industry publication without running into them.

To say the environment around Biosimilars is fluid would be an understatement. With fluidity comes uncertainty and with uncertainly comes opportunity. Many industry pundits are evaluating the Biosimilar market by taking a big picture, macro assessment of the regulatory, clinical development, and commercialization issues.

This is a “Primer” and is not intended to cover the full range of issues currently at the heart of Biosimilar discussions. Rather, we believe this report serves as a very good starting point for sponsor/ innovator companies, generic manufacturers, and contract research organizations to begin to understand the thoughts and beliefs of US payers. We interviewed 30 high-level respondents from US-based Managed Care Organizations who are responsible for making formulary decisions.

  • Familiarity US payers have with Biosimilars and their top-line concerns
  • Current and future formulary decision-making structure around Biosimilars
  • US Payers’ view on reimbursement levels, including price expectations, reimbursement policy, and pharmacy-level substitutions
  1. Pharmacy-level substitutions viewed from the perspective of Physicians, Pharmacists, and Payers
  2. Familiarity with Biosimilars
  3. Concern for safety and efficacy
  4. Discounting expectations
  5. Reimbursement for Biosimilars

ISR understands that you’re looking for confidence in your market research. With ISR, you’ll consistently receive

  • Focused Domain Expertise — We’ve operated in pharmaceuticals for over 15 years and because it’s our sole focus, our domain expertise brings value to the work that “generalist” researchers can’t deliver.
  • Genuine Research Expertise — Our market research experience has developed over 20 years in many dynamic industries.  We capture appropriate sample sizes, given the research objectives, and we use appropriately sophisticated statistics to uncover everything that’s real and to give you confidence in your decisions. Read our Six Questions to Ask About Your Market Research to learn more about why our industry expertise sets us apart.
  • Transparency — If you’re like many, you’ve been disappointed more than once by research providers who fail to live up to their promises, providing you with their “professional judgment” in place of sound data; and suspect contacts instead of real decision-makers. We deliver the beliefs, attitudes, and intentions of people who matter – and we’ll prove it by showing you the titles of your respondents.

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