Opinion
Video
Optimizing the Implementation of Biosimilars Into Formularies
Panelists discuss how health systems can learn from published case examples when implementing biosimilars, noting that biosimilars can create a “win-win” situation where patients see lower costs, payers see lower charges, and providers may experience better margins.
Health System Implementation and Pricing Strategies
Key Themes:
- Learning from Experience: Health systems can learn from published literature on biosimilar implementation, including European experiences where products have been available for longer periods.
- Pricing Structure Considerations: The industry is shifting from high wholesale acquisition cost (WAC) with large rebates toward lower upfront pricing models in response to public pressure for transparency and reduced pharmaceutical costs.
- 340B Program Benefits: Biosimilar manufacturers typically extend 340B discounts where originator products might have protections, creating additional savings opportunities for eligible sites.
Key Points for Physicians:
- Learning from published implementation experiences prevents repeating mistakes and streamlines adoption.
- Beyond direct acquisition costs, consider additional financial benefits such as 340B program eligibility when evaluating biosimilars.
- Biosimilars can create “win-win” scenarios with lower patient costs, reduced payer charges, and potentially improved provider margins.
Notable Insights:
The industry trend toward low WAC pricing reflects growing criticism of inflated list prices with large rebates, leading to more transparent pricing models.
Clinical Significance: Biosimilar implementation offers multifaceted financial benefits beyond simple acquisition cost savings, including program eligibility considerations and value optimization across the care continuum.
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