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.
Transcript
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.
Award-Winning Poster Presentations From AMCP 2024
April 23rd 2024At the Academy of Managed Care Pharmacy (AMCP) 2024 annual meeting, multiple poster presentations concerned with health equity, data collection, glucagon-like peptide-1 agonists, and more were acknowledged for their originality, relevance, clarity, bias, and quality.
Read More
Empowering Community Health Through Wellness and Faith
April 23rd 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In the third episode, Camille Clarke-Smith, EdD, MS, CHES, CPT, discusses approaching community health holistically through spiritual and community engagement.
Listen
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
Read More
Overcoming Employment Barriers for Lasting Social Impact: Freedom House 2.0 and Pathways to Work
April 16th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our second episode, in which we learn all about Freedom House 2.0 and the Pathways to Work program.
Listen
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More