Opinion
Video
The Biosimilar Shift: How PBMs Are Reshaping Formularies
Panelists discuss how major PBMs' (pharmacy benefit managers) decisions to prefer biosimilars over reference biologics provide valuable insights into successful adoption strategies, specifically examining CVS Caremark's removal of reference biologic adalimumab from national commercial template formularies, which resulted in 97% of prescriptions being filled with preferred biosimilars, and analyzing the key implementation factors driving this remarkable conversion rate.
PBM-Driven Biosimilar Adoption: Lessons for Physicians
Strategic Formulary Changes and Market Impact
Recent decisions by major PBMs to designate biosimilars as preferred agents over reference biologics provide the following valuable insights into effective adoption strategies:
- Formulary design is a powerful driver of biosimilar utilization.
- Decisive exclusion policies can rapidly shift prescribing patterns.
- Market competition intensifies when PBMs leverage their scale to negotiate favorable biosimilar pricing.
- The transition to biosimilars can occur more rapidly than previously anticipated when structural barriers are removed.
CVS Caremark Case Study: Adalimumab Biosimilar Implementation
CVS Caremark's removal of reference biologic adalimumab from major national commercial template formularies has yielded remarkable results, with 97% of prescriptions being filled with preferred biosimilars. Key lessons from their implementation program include the following:
- Clear communication strategies with prescribers and patients are essential for successful transitions.
- Comprehensive education about biosimilar safety and efficacy helps overcome hesitancy.
- Streamlined prior authorization processes facilitate smoother conversions.
- Coordinated pharmacy support services minimize disruption to ongoing therapy.
- Monitoring systems that track patient outcomes maintain confidence in the transition.
- Effective implementation can achieve near-complete market conversion in a relatively short time frame.
These findings demonstrate that decisive PBM formulary policies, when coupled with comprehensive implementation strategies, can dramatically accelerate biosimilar adoption and potentially generate significant cost savings across the health care system.
