Optimizing the Transition to Biosimilars: Considerations for Payers - Episode 3

Increased Use of Biosimilars

Ryan Haumschild, PharmD, MS, MBA, and Kathy Oubre, MS, discuss the increased use of biosimilars, including successes and challenges and the process of transitioning to biosimilars at their organizations.

Ryan Haumschild, PharmD, MS, MBA: The uptake of biosimilars is something we’ve been working on over the past few years. As biosimilars came to market initially, a lot of people were hesitant, and rightfully so. What does a biosimilar mean? What does it mean when it’s highly similar to the reference product, and how do we utilize these medications? Many of us were forced to use biosimilars in the supportive care side when we think of medications like pegfilgrastim. Those initially came to market and soon after, the last couple of years we’ve had a lot of pegfilgrastim biosimilars for supportive care measures, and we’ve had to adopt it. Because not only did we want to decrease cost of care, but payers started mandating it. As health care facilities, to comply with payer mandates we had to get familiar with these medications and utilize them.

That’s 1 area where biosimilars started to gain understanding—within health care providers, within the pharmacy team members—of what benefits biosimilars bring to the table. After we had biosimilars, we got comfortable with them in the supportive care arena. All of a sudden, we started to see newer biosimilars come forward in the therapeutic area, in the treatment space. This is something that gained a bit of hesitancy at first, just as it did when biosimilars were brought through supportive care, because we’re treating patients who might be curative in therapy or metastatic with a biosimilar, not the reference product.

What we did was leverage the great data that we saw in Europe. Europe has been using biosimilars since 2008. We’re able to see what their real-world evidence looked like. We’re able to translate that in our health care system. We still have some challenges with people concerned about immunogenicity: how do we create uptake, how do we add these medications to formulary, do we consider them equivalent. Those are decisions that we’ve methodically thought through and come up with plans for. Those were the initial challenges that came up. Successes are: We’ve been able to provide medications with good clinical efficacy at a reduced cost of care, which has been helpful. We’ve been able to comply with some of our payers, meeting value-based goals and reducing the cost. Last, we’ve been able to reduce co-pays for some patients by bringing them a more cost-effective therapy and utilize it for their treatment. Those are some of the barriers and successes we’ve seen with biosimilars coming to market.

Kathy Oubre, MS: Our biggest success with biosimilars has been increased access to care for our patients. Biosimilars allow us to offer these potentially life-saving medications at a lower out-of-pocket cost to our patients. The estimated cost savings per dose for our patients has been $500 to $1400 for some of the more expensive therapeutic products. These types of cost savings have been more crucial during the pandemic as disparities in care have come to the forefront of our lives as health care providers.

As many people continue to be faced with job and financial insecurities as a result of the pandemic, we’re going to see that problem moving forward. The cost savings of biosimilars has helped many people continue to afford their treatments. Some challenges that we see at Pontchartrain Cancer [Center] have been more operational in nature because of the requirement to stop multiple biosimilars and perhaps the originator because of variation in payer formulary. This has led though to an increased risk from an operational perspective if a nonauthorized biosimilar is administered to the wrong patient. If this happens, there’s a good chance the practice won’t receive payment from the payer.

We haven’t seen a big difference in our success or challenges around supportive care or therapeutic biosimilars from an operational perspective. However, in looking at our patient population as a whole, we’ve seen a lot more success due to an increase in access to care around the therapeutic agents because there are more of them. That does consequently lead to more of an increased risk in ensuring that the correct patient receives the approved drug.

Ryan Haumschild, PharmD, MS, MBA: What was the catalyst for us to implement biosimilars? It was multiple factors, but first it was the payers. Payers started seeing that they could provide a therapeutic medication, approve it, and have equivalent efficacy because it’s highly similar. It’s the biosimilar. We had to start looking at them. We also were starting to look at how to reduce cost of care for our patients and our organization. That was the start of how we explore biosimilars further, especially now that we know they’re highly similar to the reference product and should give an equivalent clinical response.

That process started with creating a survey across organization, understanding what were the barriers. What were the concerns from our provides? Was it immunogenicity? Was it enough data in the curative intent patient population? What were some of the barriers from finance from our EMR [electronic medical record] in terms of how we build these out quicker? Once you grapple with those topics and understand your biggest barriers—or what I consider the biggest areas of opportunity to learn more about biosimilars—you start to see the benefits of biosimilars. You answer some of the questions people have. It creates better transition for biosimilars into an organization, ultimately utilizing them within patients while reducing total cost to care.

Kathy Oubre, MS: Our transition to biosimilars happened a week and a half after the first biosimilar hit the market. Given that there are multiple biosimilars and the innovator to choose from, we felt that it was important to have fairly specific and detailed workflows around implementing biosimilars to minimize operational errors. First, our nursing director reviewed and continues to review all new orders and substitutes the biosimilar from the originator. They’re cross-referencing this with the list of approved biosimilars or reference products by each payer. Unless that payer insists on an originator or a biosimilar not in our EMR—we have our internal formulary to manage that with. We also run weekly reports out of our EMR to identify all existing patients who are eligible to switch to a biosimilar based on indication and payer. Next, follow that consultation with the physician. The pharmacist substitutes the biosimilar, and patients are then educated and reconsented for the biosimilar. After that, those new orders go to our financial and authorization teams to get the new product authorized and update the patient’s out of pocket.

This transcript has been edited for clarity.