Bill Would Allow Insurers to Switch Patients to Cheaper Autoimmune Drugs
核心洞察
California Senate Bill 1094 would allow insurers and pharmacists to substitute brand-name biologics with lower-cost biosimilars unless the treating physician objects.
The bill requires 60 days' notice to doctors and patients and annual health plan reporting on how biosimilar (搜索) savings are applied.
A legislative analysis estimates $87.7 million in annual premium savings, under 1%, with out-of-pocket savings of $92 to $310 per patient.
California Senate Bill 1094, authored by Sen. Akilah Weber Pierson, is awaiting Governor Gavin Newsom's signature and would let health insurers and pharmacists substitute a patient's brand-name biologic (搜索) for a lower-cost biosimilar (搜索) unless the patient's doctor objects. Plans would have to notify doctors and patients 60 days before any switch. Nearly 25,000 Californians on brand-name biologics could see prescriptions switched as early as next year.
State health officials report insurance spending on medications rose 72% between 2017 and 2024, with biologics a major share, and six of California's 10 most expensive drugs are biologics. A legislative analysis estimates the bill would trim about $87.7 million annually from premiums, a reduction of less than 1%, with out-of-pocket savings of $92 to $310 per year depending on plan. Biosimilars typically cost 15% to 35% less than brand-name equivalents, according to research published in JAMA Health Forum.
The insurance industry, business groups and some labor unions supported the measure. Rheumatology groups and patient advocacy organizations objected that switching for cost rather than medical necessity could disrupt working treatment plans. Rheumatologist Robin Dore said the 60-day notice and affected-patient list, sought by the California Rheumatology Alliance, gives physicians time to weigh in, and that some patients already switched after insurers dropped brand-name coverage have seen no noticeable savings. Weber Pierson said patients who do not respond to a biosimilar (搜索) could switch back.
https://hsjchronicle.com/bill-aims-to-lower-costs-by-letting-insurers-switch-patients-to-cheaper-autoimmune-drugs/