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Switching Among Biologics for Patients With Psoriasis


Bhavesh Shah, PharmD, elaborates on switching biologics in psoriasis treatment.

Ryan Haumschild, PharmD, MS, MBA: Dr Shah, this question is for you. As we look at these data, and I think it’s important to look at it, there’s also the important thing that really inspired us to look at it because it was clinical outcomes, but also it was the higher cost of care, something that you’re very familiar with in the payer arm, as we have patients who are switching between agents. My question for you is, when you’re looking at a patient population, do you also pay attention to the switching that’s occurring with these biologic agents and psoriasis? Do you also see that as an area to streamline and reduce overall cost? I’d love for you to chime in on, are you tracking the switching, and do you understand the impact of total cost of care, if it’s something that’s not on your radar yet?

Bhavesh Shah, PharmD: It’s a great question. And yes, I think this is something that, as Dr Groves mentioned, obviously there’s a loyalty perspective that’s different in that market. But in our market, we have those patients who are pretty much there for a very long term, and we can track these data over a long time. Being an IDN [integrated delivery network], we have access to inpatient, outpatient, medical, pharmacy, ED [emergency department] visits, all of those claims, essentially at our fingertips for a very long time. We could actually look at the total cost of care, what happens to a patient who started on biologic No. 1, and then what happens to a patient who started on biologic No. 2. Then essentially if most patients who are actually on biologic 2 are switching to biologic 1, or having a high total cost of care, that’s going to really shift how we cover that product. Because if there’s a higher total cost of care for one biologic versus the other for treatment initiation or even subsequent therapy, and from a formulary perspective, we know that a lot of these biologics are positioned pretty much same in regard to coverage. Thus, essentially that could really help us in terms of managing the formulary better, where if we see that there’s a total cost of care that’s higher with biologic X, then we’re going to probably put that as a step therapy, where we’re not going to cover it as a primary biologic. And if there is a lower total cost of care, then that’s going to be our preferred [biologic], especially if Medicaid doesn’t have a preference of which product they prefer.

We do see that happening essentially with even other agents that we’re evaluating. But I think the key is having those long-term data to be able to make the decisions, and then also pulling in experts like Dr Lebwohl into our decisions. We don’t just make these decisions because we saw these data. We actually want to validate and see that this is making sense. We also pull in our experts to help us make these types of determinations in coverage and use real-world evidence to make that type of treatment decision, like you said, personalized therapy for patients with specific diseases.

This transcript has been edited for clarity.

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