The Inflation Reduction Act's temporary reimbursement incentives for biosimilars are demonstrating measurable impact on adoption rates across US healthcare facilities, according to new survey data from Certara analyzing the policy's effectiveness two years after implementation.
The IRA provision, which took effect in October 2022, allows the Centers for Medicare & Medicaid Services to provide 108% reimbursement of the originator product's Average Selling Price for qualifying biosimilars, compared to the standard 106% reimbursement rate. This 2% boost was designed to encourage healthcare providers to overcome administrative barriers that have historically slowed biosimilar adoption.
Survey Reveals Broad Awareness and Adoption
Certara's survey of 79 healthcare facilities examined utilization patterns for 17 oncology and supportive care biosimilars and five reference products. The findings revealed comprehensive awareness of the IRA provisions, with 95% of respondents indicating their administration is at least partially aware of the reimbursement changes.
Facility size correlated strongly with awareness levels, as larger institutions demonstrated greater familiarity with the reimbursement modifications compared to smaller facilities. This awareness gap translated directly into utilization patterns, with highly aware facilities using an average of eight biosimilars versus 5.4 biosimilars at facilities with low or no awareness of the IRA changes.
The survey found broad biosimilar utilization overall, with 91% of facilities using at least one of the referenced biosimilars, averaging six products per facility. Facilities not using biosimilars cited reimbursement challenges and provider choice as primary barriers.
Financial Incentives Drive Decision-Making
Net price emerged as the dominant factor influencing biosimilar adoption, with 65% of respondents identifying it as the primary reason for use. Contracting considerations ranked equally important, while clinical equivalency appeared as the next most significant factor at 45% of facilities.
Notably, 32% of respondents identified the IRA's reimbursement incentives as a major driver of biosimilar use, demonstrating the policy's measurable influence on prescribing decisions. When asked directly about the IRA's impact, 45% of facilities reported slight increases in biosimilar utilization, while 14% noted significant increases. Only 21% experienced decreases, with 20% reporting no change.
Future Outlook and Market Potential
Looking ahead, 89% of survey respondents believe biosimilar use will increase over the next five years, with 74% expecting the IRA add-on payments to contribute to this growth. The temporary five-year reimbursement enhancement period provides a window for establishing familiarity and acceptance of biosimilar products within the healthcare system.
The survey results highlight significant untapped potential in the US biosimilar market. While biosimilars have generated $12.6 billion in cost reductions in the United States, this figure pales in comparison to Europe's €50 billion in savings since 2012. Given that the North American market is more than double the size of the European market, the performance gap suggests substantial room for growth.
Addressing Persistent Barriers
Despite progress, several barriers continue to limit biosimilar adoption. Knowledge gaps among clinicians and patients remain problematic, along with complex reimbursement systems that don't consistently reward biosimilar use. Contractual arrangements favoring reference products and limited interchangeability designations also impede uptake.
The recent introduction of biosimilars to Humira (adalimumab) represents a potential turning point for biosimilar revenue generation in the US market. As the market matures and clinical experience with biosimilars grows, healthcare institutions are developing more sophisticated tracking systems and standardized implementation protocols.
The Certara report authors concluded that "oncology and supportive care biosimilars have achieved significant market share, saving the US healthcare system millions of dollars. While most of these savings are attributable to other causes, our primary research and market data analysis suggest that the IRA's Medicare reimbursement boost for qualifying biosimilars is a small but measurable contributing factor."
