Optimizing the Transition to Biosimilars: Considerations for Payers - Episode 6
Ryan Haumschild, PharmD, MS, MBA, and Kathy Oubre, MS, discuss tracking their use of biosimilar by their providers and outcome measures they utilize to monitor biosimilars.
Ryan Haumschild, PharmD, MS, MBA: We always try to look at our dispense reports, and that’s across every medication. We want to make sure we’re utilizing medications consistently for all our patients, and we do that mainly because we want to make sure if there are any abnormalities that we’re able to pick up on them. Also, when we move forward with a formulary approval and build them into our order sets, we want to make sure that utilization is consistent and predictable. That way, we can staff accordingly, generate pars, and make sure any contracts or any type of purchasing volumes that we’re looking at are consistent across the board. With biosimilars, do we track usage of biosimilars? We do track usage of biosimilars to make sure that we’re providing consistent care and we have enough drug on hand. We believe our providers have the buy-in for biosimilars, so that’s not an issue for us. They’re the ones who wanted to use biosimilars and implement them. We track for operational excellence, but otherwise we don’t create a report card provider. That’s not something that we do because we feel like we have good buy-in from the greater group.
Kathy Oubre, MS: We do track by provider and as an organization. Currently, we run biweekly reports out of our EMRs [electronic medical records] to identify patients as a whole and individually and prescribe a provider for each biosimilar and innovator product. This allows us to monitor our biosimilar adherence. We’re at around 95%. It allows us to identify and track anomalies, such as human error, on the practice side at the prescribing or authorization level. It allows us to track usage of individual biosimilars and innovators by payer and by product. And last, we measure this when reviewing the impact biosimilars have had on our overall drug spend and how that biosimilar usage has increased patient access and driven down cost to the patient as a whole.
Ryan Haumschild, PharmD, MS, MBA: You have to look at outcome measures because you want to have some measure of success for any type of strategy. One of the main reasons you want to adopt biosimilars is to reduce cost of care, reduce the number of denials, reduce the number of denials on a patient, and reduce their out-of-patient expenses if possible. We know that financial toxicity is such a barrier in cancer care. We did evaluate some of these measures of success because a lot of the payers are requiring biosimilars. When we were starting to utilize the reference product, we would get a denial from the payer. We’d have to switch to the biosimilar and then hope we have a successful precertification that would allow that patient to be treated and that we would end up getting paid for that claim.
When we weren’t adopting biosimilars we had more denials. That means the insurance company asked us to use the biosimilar, and we didn’t have enough time to switch it out or have the biosimilar on formulary. Then that patient would have to figure out what to do. By implementing biosimilars and reducing that denial rate, it improved our operational excellence and reduced that out-of-pocket expense for patients. At the same time, when it reduces your total cost of care, you’re helping meet those organizational goals. That’s what you need to be focused right now, when we have so many high-cost therapies: how to reduce that cost to care and how to track that reduction and expense for an organization. Those are the measures of success that we try to focus in on when we consider biosimilars.
Kathy Oubre, MS: We know which patients are receiving which product. We look at those biweekly to see if we’re seeing an increased toxicity at any level as a result of a particular product, whether they’re coming in for more hydration or more phone calls to the practice. We monitor this biosimilar conversion in reviewing our drug acquisition costs vs our reimbursement, then we closely monitor the number of patients on any particular drug. Conversely, we’ve seen a large increase in access to care within our organization as a result of these biosimilars, and that decreased out of pocket for our patients.
This transcript has been edited for clarity.