Opinion
Video
Payers and PBMs Impacted by Biosimilar Integration
Alice B. Gottlieb, MD, PhD, leads a discussion highlighting biosimilar utilization impact on payers and pharmacy benefit managers (PBMs).
This is a video synopsis/summary of a panel discussion involving Ryan Haumschild, PharmD, MS, MBA; Alice B. Gottlieb, MD, PhD; Bincy Abraham, MD, MS; Jamie T. Brogan, APRN; and Vibeke Strand, MD.
Haumschild asks Gottlieb about her experience with payer and pharmacy benefit manager (PBM) coverage of adalimumab (Humira) biosimilars.
Gottlieb says payers and PBMs have almost 100% influence over options. She has no experience yet with adalimumab biosimilars, though they are formulating policies. With infliximab and rituximab biosimilars, use is 100% mandated by the hospital with no branded options. She urged payers and PBMs to ensure lower patient costs and increased access, especially for Medicare patients.
Abraham says payer coverage influences prescribing. If multiple adalimumab biosimilar options are covered, she would choose based on factors like citrate-free formulation, available doses for induction/maintenance, indication-specific data, patient co-pay assistance, and ease of access/prior authorization. It is still early to judge current payer flexibility.
Video synopsis is AI-generated and reviewed by AJMCÒ editorial staff.
