Employer Opportunities With Biosimilars - Episode 5
A review of the first step of the National Alliance of Healthcare Purchaser Coalitions’ (NAHPC) 4 key action steps to promote biosimilar uptake.
Mohannad Kusti, MD, MPH: I would like also to mention that the National Alliance of HealthcarePurchaser Coalitions [NAHPC] had published an action brief, I believe this was in July 2018, and it was specifically about the value of biosimilars and improving treatment access and lowering cost nationwide. In that document, there were 4 action steps for employers to promote biosimilar uptake.
In this document that I mentioned from the NAHPC, the action steps for employers, the first one is to quantify the biosimilar opportunity by initiating conversations within vendors such as the health plans, the pharmacy benefit managers [PBMs], and the specialty pharmacy provider. This discussion will help initiate a better understanding of the fill rates, the potential savings from utilizing biologicals versus biosimilars, and also the availability of the biosimilars to the members covered under the plan.
Part of step 1, as I mentioned, was to have that understanding of fill rates and savings potential. I would recommend the employers start talking to their account manager, executive account manager for their PBM vendor, and also discuss this if the employer has a pharmacy benefit consultant. That would be another resource for the employer to go to and have these detailed discussions. These can differ between states, regions, and different industries, so I think it’s a very important conversation to be had on specifics and on a case-by-case basis.
Another resource for talking about these things is if the employer belongs to any of the employers’ coalitions or employer health care purchaser coalitions, that would be another resource for employers to reach out to and have these discussions and talk to those on the teams to assist with a better understanding.
Part of that step 1 is to have a better understanding on the opportunities and how they vary between different employers who are self-insured and self-pay versus employers who are commercially insured, because these health plans are handled in a very different manner. Employers who are self-insured may have a lot more control on the benefit design, what is covered under their formulary, and how to make it available to their lives covered, versus the employers who are not self-insured. Those not self-insured have commercial insurance and may not have as much ability to make changes to the plan.