Dr Fran Gregory Discusses the Impact of the New Wave of Biosimilars on Rebate Practices

Fran Gregory, PharmD, vice president of emerging therapies at Cardinal Health, discusses the role the new wave of biosimilars will have on rebate practices for both pharmacy benefit managers (PBMs) and payers.

The new wave of biosimilars will shed light on strategies for affordability and accessibility of these drugs coming to the market, says Fran Gregory, PharmD, vice president of emerging therapies at Cardinal Health.


What are the regulatory and policy considerations related to this new wave of biosimilars and their impact on specialty pharmacy?

Sure, there are many! The first thing that comes to mind is kind of the closer look at rebate practices that PBMs [pharmacy benefit managers] and payers implement across their formularies and really, how they do business.

When we think about biosimilars and biosimilars coming to market and thriving in the market, they have to overcome what we call this rebate cliff, right? So, they have to beat the rebates that the reference product companies are offering to these payers and PBMs. And sometimes that's very challenging. And we'll see that as we see the adalimumab biosimilars come to market. We'll see some of that—not completely transparently—but you'll see it behind the scenes, that maybe not all plans are preferring a biosimilar. Although we all know they're more affordable or lower cost, we'll see that the brand or the reference product is being preferred on certain formularies.

There was an analysis done recently where it showed all the large payer PBMs and which ones of those preferred biosimilars more frequently. And it was very obvious that not all payers are the same in this regard.

Some payers have reference product first strategies and that is what is financially incentivizing to them and that's what makes financial sense to them at that time. As a specialty pharmacist, and knowing this market, and knowing the opportunities and the affordability that biosimilars intend to bring, we just really hope that some of these rebate policies and some of the closer look into some of those practices will really kind of shed a light on the fact that biosimilars do promise affordability and accessibility. But we have to think about the big picture about the long term, to really recognize the value that they're here to bring.

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