Physician-Level Cost Control Measures and Regional Variation of Biosimilar Utilization in Germany

Abstract

Biologic drugs represent a large and growing portion of health expenditures. Increasing the use of biosimilars is a promising option for controlling spending growth in pharmaceutical care. Amid the considerable uncertainty concerning physicians’ decision to prescribe biosimilars, explicit cost control measures may help increase biosimilar use. We analyze the role of regional cost control measures for biosimilars and their association with physician prescriptions in ambulatory care in Germany. We collect data on cost control measures implemented by German physician associations and national claims data on statutory health insurance covering 2009 to 2015. We perform panel regressions that include time and physician fixed effects to identify the average associations between cost control measures and biosimilar share/use while controlling for unobserved physician heterogeneity, patient structure, and socioeconomic factors. We identify 44 measures (priority prescribing, biosimilar quota) for erythropoiesis-stimulating substances, filgrastim, and somatropin. Estimates of cost control measures and their consequences for biosimilar share and use are heterogeneous by drug, measure type, and physician group. Across specialists, biosimilar quotas accounted for 5.13% to 9.75% of the total average biosimilar share of erythropoiesis-stimulating substances. Explicit quota regulations are more effective than priority prescribing. Regional variation in biosimilar use can be partly attributed to the presence of cost control measures.

Prescription Behaviour and Barriers to Prescription of Biologicals for Treatment of Chronic Inflammatory Skin Diseases in Dermatological Practice in Two German Federal States

“…The prevalence of such barriers may be minimized in the future with the introduction of biosimilars, leading to a reduction in treatment costs ( 37 ). However, new requirements for cost reductions, such as biosimilar quotas ( 38 ), could possibly increase concerns and confusion among dermatologists and represent a newly emerging barrier.…”

Policy measures and instruments used in European countries to increase biosimilar uptake: a systematic review

“…In Germany, prescription quotas and prescription targets (maximum pharmaceutical budget defined by period, region, specialty or physician) are used to encourage biosimilars prescription in the outpatient setting, accompanied by financial penalties ( 42 ). Quotas are often used by German medical associations to control costs and reduce uncertainty among regular prescribers ( 23 ). In Belgium, physicians must consider the prescription quota of “low-cost medicines.” In this sense, physicians are encouraged to prescribe at least 20% of biosimilars to naïve patients ( 47 ).…”

“…Policy measures and instruments on both the supply and demand sides have an impact on the market share of biosimilars ( 23 – 25 ). Price and reimbursement policy measures, stakeholder incentives for biosimilars use, as well as the level of education and awareness, lead to variations in the use of these drugs ( 24 ).…”

Learnings from Regional Market Dynamics of Originator and Biosimilar Infliximab and Etanercept in Germany

“…Instead, the current study examined regional variations in biosimilar uptake in order to derive practices/incentives influencing biosimilar use. Studies published by Moorkens et al [ 17 , 18 ] followed this approach and were among the first to identify factors driving biosimilar use through quantitative analysis [ 52 , 53 , 54 ]. According to Moorkens et al, the absolute/relative difference in discounted price between originator and biosimilars influence decision-making regarding biosimilar use in Sweden [ 17 ].…”