New Resource: Biosimilar Substitution State Statute Report

  • This page as PDF

Summary

Avalere’s report, available now, offers insights into state policies on point-of-service substitution of biosimilar products.

In today’s rapidly evolving healthcare landscape, biosimilars have emerged as an option to address the demand for cost-effective and high-quality treatment options. A biosimilar is a type of biological product that shows no clinically meaningful differences from a reference Food and Drug Administration (FDA)-approved biological product. As with generic drugs, biosimilars are a subsequently approved version of the reference product and can be a clinically appropriate and less expensive option for patients. Even though there are similarities, generics are not the same as biosimilars: While both are lower-cost alternatives to brand drugs, biosimilars may not be chemically identical to their reference compound, unlike generics.

However, the complexities of biosimilar substitution statutes remain a challenge for prescribers, pharmacists, payers, and manufacturers. Avalere experts have created a comprehensive Biosimilar Substitution Statute Report, for manufacturers, providers, health plans, and patient advocates that offers guidance on the steps to substitution that may impact provider prescribing, pharmacy dispensing, and patient access.

What Is In The Report?

This report provides a comprehensive summary of state statutes on the substitution of interchangeable biosimilars for their reference biologic products. Legal research software (e.g., LexisNexis, Justia US Law, State Legislation Information Sites) current as of January 25, 2024, was used to review and analyze statutes in all 50 states, the District of Columbia, and Puerto Rico that apply to the process for substitution. It highlights how these statutes can vary, detailing who is authorized to make the substitution, the circumstances under which a substitution may occur, and requirements for notification and permission.

The Biosimilar Substitution Statute Report answers key questions, including:

This report is not an interpretation of individual product interchangeability, as designated by the FDA, nor is it a recommendation for substitution or a guarantee of insurance coverage. It does not constitute legal advice or opinion; rather, it is for general informational purposes only. Until the FDA designates a biosimilar as “interchangeable,” any state statute regarding substitution based on interchangeability by a pharmacist does not yet apply. However, this report can serve as an educational tool, providing insights into interchangeability from federal and state perspectives. It is intended to help stakeholders navigate the complexities of biosimilar substitution.

Access The Report

To purchase the report, contact us.

Avalere’s experts in commercialization, regulatory, and policy  strategy can help manufacturers, patient advocacy organizations, and other stakeholders analyze the statutes and access implications to biosimilar substitution shift, and help  develop strategies to mitigate delays in patient access to biosimilars.  This report offers comprehensive analysis along with recently updated state legislature.

 

 

Webinar: Decoding the CY 2025 Advance Notice Join Avalere’s healthcare policy experts as they dissect the CY 2025 Medicare Advantage Advance Notice and discuss the future trajectory of MA in Part D and potential outcomes, headwinds, and tailwinds for health plans. Learn More
Watch the Recording
Back To Top