Articles

HEALTH SCREENING

Cost Implications of Selective Preoperative Screening in the Care of Candidates for Peripheral Vascular Operations

DISEASE MANAGEMENT

Disease Management Interventions to Improve Outcomes in Congestive Heart Failure

CLINICAL MEDICINE

Sedating Effects of AM/PM Antihistamine Dosing with Evening Chlorpheniramine and Morning Terfenadine

CASE STUDY

Physicians in Training as Quality Managers:  Survival Strategy for Academic Health Centers

Hello, I’m Matthew Gavidia. Today on the MJH Life Sciences News Network, The Center for Biosimilars® is pleased to welcome Ryan Haumschild, PharmD, director of pharmacy at Emory Healthcare [in Atlanta, Georgia].  

Can you introduce yourself and tell us a little bit about your role at Emory Healthcare?

Absolutely. So, my role is pretty extensive. I oversee all of our infusion pharmacy services for our Winship Cancer Institute, a comprehensive cancer center, as well as our nononcology infusion centers that deal with pulmonary illnesses, dermatology, gastroenterology, rheumatology and viral hepatitis. I also oversee our specialty pharmacy services, our clinical practice model, our 340B [drug pricing] program, and finances for the department.

CfB: Can you describe the Emory Healthcare system, particularly the types of health care offered, and the number of providers and territory covered?

So, we're a large integrated delivery network located in the southeast. We have a large patient poll since we're located in one of the biggest cities in the United States. We have 11 hospitals in our system, and we have over about 2000 providers and a number of affiliates that work with us. So, it's a relatively large system with around 22,000 employees in total.

CfB: What is the extent of the use of biosimilars prior to embarking on a program to broaden use? Is there administrative interest in the greater use of biosimilars?

Initially when biosimilars came to market, there was a lot of people that were skeptical. What does this mean for us? What does it mean for our program? We didn't have a huge uptake at first. The only time we used biosimilars were in our growth factors and that was mainly because insurance companies started to require them. It wasn't something that we were choosing to use initially.

The administrative burden of biosimilars is a little more difficult just because you have to carry many different products on hand. Especially with us having so many infusion centers across the greater Atlanta area, it's really my team responsibility to make sure we have enough inventory on hand, and that we're also reducing our carrying costs to keeping our inventory turns within our financial goal range.

CfB: What were the rationale and the strategy that led to your decision to do the survey?

As biosimilars came to market, we realized we couldn't just sit back and not partake. We recognized that some patients were being forced to use biosimilars. And so, if some patients are being forced to use them, we needed to evaluate the safety, efficacy and appropriateness [of biosimilars] for all of our patients.

So, that really led us down the path to figure out how we should start this. I think the first method that we decided to utilize was doing a baseline survey. We really surveyed our entire faculty through the College of Medicine and our providers that practice in our clinic, both APPs [advanced practice providers] and PharmDs to figure out everyone's comfortability [with biosimilars], their hesitations [for prescribing them] and what concerns need to be addressed on the front end before we start to ramp up use.

CfB: What exactly did the survey findings tell you?

Initially, survey findings for people are hesitant. A lot of people weren't sure what to do. They wanted other people to utilize [biosimilars] first. A lot of people felt comfortable with their [reference products] and medications that they've been practicing with for a longer period of time. So, there were hesitations there.

The other question is do we really have to move forward with this plan? There seem to be a lack of education, even though we have some of the top providers in the country. I think that lack of familiarity and because they weren't on the clinical trials, they had some hesitations, especially with the expedited approval pathway through the FDA.

CfB: What goals did you develop based on those findings? Can you describe your action plan for moving forward with them?

We wanted to get the baseline satisfaction of physicians working with these products, and our goal was to increase utilization. We actually had an internal marker to see if we can at least get [physicians] above 30% utilization with biosimilars. At the time, there was OPPS [outpatient prospective payment system] reduction and reimbursements. So, biosimilars had a better reimbursement pathway.

And we recognize that not only is it important to recognize the value and efficacy for our patients that are being forced to use [products] based on payer preferences, but at the same time, [it's important to know] how we can increase our utilization rates to control the total cost of care for patients. The other thing we want to do is get an understanding of how we could improve the baseline understanding from providers and patients.  What are the preferences of providers and can those preferences be changed to biosimilars as we move forward with our education strategy?

CfB: How can these initiatives be implemented? Were there any challenges you encountered and subsequently overcame?

There were challenges. I feel like a lot of providers were open to biosimilars but maybe for [treatment naïve patients], they didn't want to [use them interchangeably]. A lot of providers still had their preferences and biosimilars could've be an option if insurance dictated it, but [providers] still wanted to use [reference products] initially. So, those were some of the barriers we had to work through. We had to work through telling [them about] reimbursements and how we can still get paid for utilizing these medications. There's still an option for patients so they don't have increased out-of-pocket expenses.

Even looking at some of the real-world data and talking with our European colleagues to see how we can utilize and leverage their experiences with biosimilars and translate that into our comprehensive cancer center.

Lastly, one of the barriers for us was that [Emory Healthcare is] known across the Southeast for providing the best cancer care possible. And so, we had to ensure that our outcomes would be the same or better, if we started to incorporate biosimilars within our health plan and our Cancer Center.

CfB: What do you think was achieved through this program? What differences were made and what goals lie ahead with respect to achieving greater use of biosimilars?

I would say that we've started to increase biosimilar use. Providers have been on board. And I've got to tell you, we've had some great physician champions that have helped utilize biosimilars, evaluated the impact of biosimilars and got it through P&T [pharmacy and therapeutics committees], as pharmacies have a really huge influence on the utilization of biosimilars. They even established a collaborative practice agreement with our physician providers so that we can make those switches when necessary.

I think even having biosimilars as the preferred formulary agents, depending on the disease state, is also a huge win. So, that's really where we've been. I think in the future [we need to figure out] how to continue incorporating biosimilars not just within oncology, but [also for] our nononcology disease states. [We need to figure out] how to leverage more real-world data. We're actually looking at studies we can do internally to validate that biosimilars do not change outcomes so that we can make our physician colleagues feel more comfortable using them.

And lastly, we have affiliates that sign on within our health system and they really don't have a lot of education or resources to learn about biosimilars. So, now, I'm trying to leverage our data and experiences to tell that story of success to others.

CfB: Do you feel that the trepidation you encountered among physicians toward biosimilars is still largely a feature of many health care systems in the United States? 

I really do. As much as some of us large IDNs [integrated delivery networks] have been able to get through the barriers of biosimilars, I still see a lot of hesitation, especially with our community providers that may practice occasionally in our infusion center. I find that they may be hesitant around biosimilars. Some of our affiliate sites that don't have large research programs or a super strong pharmacy presence may also have a lot of [initial] hesitation there. There has been a lot of pushback. And so, that's really why I've tried to utilize our experiences and have them stand as a platform to educate others because I feel like there's a huge opportunity for biosimilars that's really untapped in a lot of the community health systems.

CfB: Do you feel that the lessons and strategies at Emory Healthcare can be successfully employed elsewhere?

You know, I really feel that they do. I mean, obviously they have to be customized. We're lucky in that we have a number of PGY1 [postgraduate year 1] and PGY2 [postgraduate year 2] board certified clinical pharmacy specialists. We have a very engaged administration and leadership team. So, that gives a lot of internal equity with physician providers. They trust us. We've earned that respect over time. I think that's given us a leg up. But I do think that we can leverage the experiences we've had with community health systems and make it applicable in helping them with their transitions. And that's something I'm really committed to. I think it's really important for the patient. I think it's important for the total cost of care. And it will help health systems pivot a little bit better when insurance companies start to dictate biosimilar use and take choices away from them.

CfB: And lastly, would you like to share any other thoughts or conclusions about this effort?

You know, I think there's still a lot of work to be done. I talked about our story of success. I think we're starting to migrate into the non-oncology biosimilar space. Again, we have a large volume of non-oncology infusions that deal with biosimilars. And so, we're leveraging our experiences with oncology to non-oncology and I see biosimilars breaking into the specialty pharmacy and non-infusible area.

My goal is not to just be 100% biosimilars, but also to give the option to [use them], have people recognize real world data and make them feel comfortable with interchangeability even if [the biosimilar] may not be labeled that way. So, I think there needs to be a lot more steps taken and a lot more education, especially with our affiliate providers. This is probably about a 2- to 3-year journey, but I'm excited to be on it. I'm excited to be on the cutting edge of it and actually having pharmacy take an active role through a collaborative practice agreement.

CfB: To learn more, visit our website at centerforbiosimilars.com. I'm Matthew Gavidia. Thanks for joining us.

Videos

HEALTHCARE UTILIZATION

Ryan Haumschild, PharmD, director of pharmacy at Emory Healthcare in Atlanta, Georgia, discussed results to the survey he conducted on biosimilar utilization and planned initiatives about how to increase physician confidence in biosimilars.
 

Ryan Haumschild, PharmD, Outlines Ways to Boost Physician Confidence in Biosimilars

Once the coronavirus disease 2019 (COVID-19) public health emergency ends, telemedicine should continue to be used to increase access and improve care for patients with rheumatic diseases, according to a position statement released by the American College of Rheumatology (ACR). ACR’s position statement also supports continued parity of reimbursement for in-office visits, audio—visual visits, and audio-only visits after the pandemic.

ACR noted that practices have been able to combat the financial strain of reduced in-person visits during the COVID-19 pandemic through the adoption of telemedicine. Policy changes enacted by CMS due to the public health emergency has allowed clinicians to be reimbursed for telemedicine services at the same rate as in-person visits, and ACR supports continued parity reimbursement in order to “preserve the economic viability of rheumatology practices.”

“As providers plan for rheumatology care post-COVID, taking into consideration rheumatology workforce shortages and geographically distant patients, it is apparent that telemedicine could help rheumatology providers improve care models for their patients if the long-term economic and regulatory landscape remains favorable,” Chris Phillips, MD, one of the statement’s lead authors and member of the ACR’s Committee on Rheumatologic Care (CORC), 

ACR noted that telemedicine should be used in conjunction with periodic in-person visits and should not replace essential face-to-face assessments. In addition, ACR stated that reimbursement parity should occur as long the provider—patient relationship includes both in-person and telemedicine services, patients have a choice of provider for telemedicine services, the standard and scope of care provided by telemedicine services is consistent with in-person services, and the provision of telemedicine services is properly documented.

The statement includes another 6 positions, most of which are supporting, as well as 2 opposing positions.

ACR also supports protecting the security and integrity of patient information, proposals that facilitate the interstate practice of telemedicine, outcomes-based research of telemedicine use in rheumatology, and continued access to telemedicine services even after the COVID-19 public health emergency ends. In addition, ACR recommends platforms with a way to obtain informed consent for the delivery of telemedicine services.

In the position statement, ACR opposes geographical restrictions on telemedicine practice and payer policies that would dictate use of specified telemedicine platforms, create restrictive networks, or use telemedicine as a way to divert patients to preferred providers.

“While telemedicine should not replace many of the hands-on skills and in-office assessments rheumatology professionals provide, patients in all areas of the U.S. should have access to telemedicine, regardless of location, and the services should be included in all subscriber benefits and insurance plans,” said Aruni Jayatilleke, MD, one of the statement’s lead authors and member of CORC. “Additionally, rheumatology professionals should be reimbursed equitably for telemedicine services and have access to a streamlined state medical license process.”

CONTINUING MEDICAL EDUCATION

The widespread adoption of telemedicine during the coronavirus disease 2019 (COVID-19) pandemic, as well as reimbursement parity that was enacted by CMS, should be continued once the public health emergency passes, according to a new position statement by the American College of Rheumatology (ACR).

December 1997

Cost Implications of Selective Preoperative Screening in the Care of Candidates for Peripheral Vascular Operations

Disease Management Interventions to Improve Outcomes in Congestive Heart Failure

Sedating Effects of AM/PM Antihistamine Dosing with Evening Chlorpheniramine and Morning Terfenadine

Physicians in Training as Quality Managers: Survival Strategy for Academic Health Centers

Ryan Haumschild, PharmD, Outlines Ways to Boost Physician Confidence in Biosimilars

ACR Supports Continued Use of Telemedicine and Reimbursement Parity After COVID-19 Crisis

Adverse Drug Reactions: A Review for Healthcare Practitioners