Defining Value With a Changing Biosimilar Landscape - Episode 3
Mariam Alboustani, PharmD, discusses the one published example of a switching study and the implications of interchangeability for pharmacists, as well as payers.
Mariam Alboustani, PharmD: If there is published clinical information in the case of Cyltezo that supports interchangeability, that would provide an additional advantage over any other biosimilars where there is no interchangeability status or no study. In the clinical study, we are seeing basically a confirmation of the efficacy, that it is a treatment that is appropriate in individual patients and is showing the same results as the reference product, also possibly the same adverse events. Also, this gives confidence to providers to use the medication, even switch patients to it. It gives confidence to pharmacists and is a big advantage for payers in case they want to put that information as a requirement in their formulary in order to switch patients from the reference product to Cyltezo, for example.
If we want to find out what the implications are of interchangeability for a retail pharmacist, we look at what a retail pharmacist is going through today as they are performing their daily duties. One of them, for example, is filling prior authorization requirements for certain health plans, also dealing with approvals, denials, appeals. In addition to that, you have pharmacists dealing daily with patients, either complaining about their copays or cost implications. With the availability of interchangeable products, look at it from 2 angles. The first angle is the pharmacist is now free, depending on state law, to switch to this interchangeable product if, for example, for the formulary of a certain health plan, this product does not require prior authorization. That is an added advantage. Another added advantage is that the patient—assuming that the interchangeable product or the biosimilar has a lower cost—has a lower cost share. You have that added advantage where the pharmacist can provide solutions for these patients and switch the product in the pharmacy, [giving a] lower cost to patients. The most important part is equal clinical efficacy [for] these patients.
For payers, the implications of interchangeability are huge. They can only be positive. Payers historically have been trying to manage high-cost drugs. They have been trying to put formulary restrictions. They have been trying to put prior authorizations, step therapy. Again, here we are assuming that the interchangeable product is going to be the cost-efficacious option for the payer. Although [payers have] been successful, there were certain limitations when it comes to prescribing habits, with certain providers pushing back prescribing the drug as is and has to be dispensed as is. Today or in the future, payers will have the extra tool in their hands to—in communication with pharmacies or pharmacists, depending on the pharmacy status—formulary permitting, [allow] the pharmacist to switch a product from a preferred to an interchangeable product in a manner that is advantageous to these payer strategies.
This transcript has been edited for clarity.