Optimizing the Transition to Biosimilars: Considerations for Payers - Episode 7
Two experts explain if they had to create any incentives for health care providers to prescribe biosimilars, whether they encountered challenges with their electronic health records, and if their biosimilar programs impacted their clinical pathway/care plans.
Ryan Haumschild, PharmD, MS, MBA: We didn’t use any incentives or require people to utilize them. We thought that if we had people understand the background of biosimilars and the benefits to the patient, the organization, and the health care system, that would help drive the narrative. That was really helpful for us in being successful. We have strong medical leaders too who understand the benefits and were able to help with some of those just-in-time conversations. That helped people understand the concept of biosimilars, be comfortable with utilizing them both in curative and noncurative intent and helping drive value to the patient.
Kathy Oubre, MS: We had started talking about biosimilars a few years ago when we knew the science was coming onto the market. By nature of our patients, and some come from rural areas and perhaps have trouble affording their medications, we’ve been watching the biosimilar market closely because we very strongly believe as an organization that it would result in increased access to care. There wasn’t a lot of education or persuading needed to get the practitioners excited about biosimilars. There wasn’t a need to incentivize any of them. As far as it being a requirement within our providers, that wasn’t needed because it was more of an opportunity for our health care providers to continue to live out our mission statement, which is to provide the best care possible to our patients while helping to reduce their financial burden.
Ryan Haumschild, PharmD, MS, MBA: There were some IT [information technology] and electronic health record challenges that we experienced from the get-go, and it was no fault of our IT team. It had to do with the amount of work that was involved for adding these products. We initially started adding a product as we approved it through formulary 1 by 1 to each order set. As you can imagine with some of these biosimilars, you’re touching greater than 100 different order sets to include a new medication. Every time a biosimilar came to market, it wasn’t feasible to keep tagging each one of these order sets to include the new product. We became a bit smarter instead of working harder, and our way was creating a unique adaptive strategy of building out biosimilars. That can be preferring a certain biosimilar and then having a subsequent biosimilar there in the order set, therefore you’re reducing the number of biosimilars that you have, or you build out a biosimilar more in a generic name. To use an example like trastuzumab, you build out trastuzumab, then you create an internal preference of which product you want to utilize in terms of biosimilar. You can substitute that specific product for trastuzumab when you go to dispense. Again, that must be blessed by a pharmacy and therapeutics–approved policy. But that allows the organization to be operationally effective, utilize the medications the provider wants without having this massive IT burden that causes a delay in giving these medications on formulary for the patient. That allows us to adopt medications more in real time, based on the payer requirements that we were having difficulty keeping up with.
Kathy Oubre, MS: As you can imagine, within our EMR [electronic medical record], every time you have a new product, you have to build a new treatment plan with your EMR. When the biosimilars came to market, that did mean a new treatment plan for every individual biosimilar that came to market. There are 19 to 21 approved products that require a treatment plan per indication per product. That number can grow quite quickly, and that does become a cumbersome process for the nurses devising those treatment plans.
We didn’t see the need to implement any new software because our EMR vendor anticipated this problem and the burden behind it. To help alleviate some of those burdens around biosimilars, there is a beta site with our EMR vendor for biosimilar integration. In this pilot, our EMR will now have a drop-down box for all of the drugs per drug class, per indication, and it will cross reference the drugs with the patient’s payer formulary. As I mentioned, it is in a beta site, and we’ve been “beta-ing” this project now for about 3 weeks and we’re working out the bugs. Our EMR vendor is extremely receptive and has been a great partner during this process. I applaud them for looking at this because as biosimilars continue to come into the market, if you look at the pipeline, we’re looking at another 20 to 30 in the next 2 to 3 years. It’s going to be important to have some automated processes and workflows around biosimilars.
Ryan Haumschild, PharmD, MS, MBA: Clinical pathways are one of the latest strategies and recommendations to create consistent quality care for patients across all spectrums of their care. Within pathways people utilize order sets, especially if they have computerized physician order entry. That’s a great way to make sure that you have the prehydration, the premedications, the treatment medications, and the monitoring all in one succinct plan that can be blessed by a greater group, like a disease state working group or tumor board. So that way, when a provider goes to order it, they know that the great discussion and consolidated plan has already been built out in the EMR. They can review it, then initiate it for a patient. Yes, within those care plans, it’s so important to build in biosimilars because that allows the provider to not have to think, “How do I order this biosimilar or that generic trastuzumab name that I’ve heard Ryan talk about?” When we can build it in there that means it’ll automatically get ordered when they initiate that plan, and it’ll follow that standard work. Then if a payer wants a different biosimilar or something needs to be substituted, that can all occur within the EMR and it helps drive utilization, but most importantly, appropriate utilization that was intended by the physician.
Kathy Oubre, MS: We don’t use clinical pathways. We do have them, but we prefer to use more of a clinical decision support tool, which is what we are doing in a separate pilot project with our EMR vendor. We have treatment plans built for each approved product per indication on an individual payer formulary.
This transcript has been edited for clarity.