Sophia Humphreys, PharmD, MHA, BCBBS

Panelists discuss how the Inflation Reduction Act (IRA) of 2022 has influenced biosimilar utilization in the US health care system through its pharmacy provisions targeting Medicare patients, examining institutional impacts on adoption patterns, exploring payer preferences between high- and low-wholesale acquisition cost (WAC) therapies under the new regulatory framework, forecasting the evolving role of biosimilars at health care institutions, and identifying persistent barriers to uptake alongside potential strategies to overcome these challenges.

Panelists discuss how stakeholders can prepare for the upcoming interchangeability designation of more biosimilars later this year, debating whether interchangeability status or formulary-level changes are more impactful and identifying necessary systemic shifts required to ensure both patients and health systems realize meaningful cost savings when transitioning from reference products to biosimilars.

Panelists discuss how major PBMs' (pharmacy benefit managers) decisions to prefer biosimilars over reference biologics provide valuable insights into successful adoption strategies, specifically examining CVS Caremark's removal of reference biologic adalimumab from national commercial template formularies, which resulted in 97% of prescriptions being filled with preferred biosimilars, and analyzing the key implementation factors driving this remarkable conversion rate.

Panelists discuss how biosimilar manufacturers offer both high-wholesale acquisition cost (WAC) and low-WAC product versions to navigate complex reimbursement landscapes, sharing their experiences with low-WAC options on formularies, defining private label agreements as strategies to improve biosimilar access across different patient populations, and examining the rationale behind PBMs' (pharmacy benefit managers) implementation of these agreements, including their specific components and benefits.

Panelists discuss how the significant price increases in reference biologics over the past decade have created market opportunities for biosimilars while exploring barriers to their adoption, potential solutions for enhancing uptake, and successful institutional strategies for increasing biosimilar utilization.

The expert panel discusses the greater potential for private label biosimilars.