Biosimilar Adoption, Legislative Action With PBMs: JC Scott

Pharmacy benefit managers (PBMs) are working with policy makers to ensure transparency requirements and other legislative actions align with their goal of providing information to empower clients and patients, says JC Scott, CEO and president of The Pharmaceutical Care Management Association (PCMA).

This transcript was lightly edited; captions were auto-generated.

Transcript

With growing interest in biosimilars and recent patent reform discussions, how are PBMs working to increase biosimilar adoption and affordability?

This is [an] area we can be really excited about. And if you look back, historically, PBMs led the way in achieving the high generic drug prescribing rate that we have today, and I think we're leading the way again when it comes to the adoption of biosimilars. The problem that we've seen historically has been 2-fold.

One is there just hasn't been enough competition in the marketplace in terms of biosimilars coming into market to help bring down costs and promote access. That is in part because we've seen some tactics by drug companies that game the systems in ways that have delayed that entry of competition, whether it's pay-for-delay settlements or misuse of the patent system, and those are things that we think need to be addressed. We're finally, kind of seeing the floodgates open there where more of the exclusivity periods are expiring. Biosimilars are able to come to market, and our companies are now actively working to encourage their clients to put those biosimilars on formulary so that they can be available to patients.

The other obstacle we've seen historically is around provider and patient comfort with making the switch from a biologic product to a biosimilar. Historically, doctors have been a whole lot more comfortable writing a new prescription for a biosimilar than they have been switching a patient that's on an established drug. We need to do more and continued education of the provider and patient community to understand the safety and efficacy of these biosimilar alternatives so that we can see that prescribing rate continue to go up.

What are the key areas of legislative focus regarding PBM reform, and how do you see these proposals impacting the industry?

There are any number of legislative proposals, both at the state and federal level, that get at the issue of prescription drug costs, and in many ways, I think, misunderstand the role the PBMs play as the only actor in the system whose job it is to bring down the cost of the drug. Whether it's legislation we see in Congress or in state legislatures, the important question we always have to ask ourselves is, “Will these proposals actually lower costs for patients? Will they promote competition? Will they preserve choice and flexibility for PBM clients in the marketplace?”

I think it is likely we will see some legislative action because there has been so much political attention to this area, and I think it will be in areas like transparency requirements, where we talked a second ago about how PBMs have leaned in to try and make sure that we are providing the information our clients and patients need to make good, informed decisions. If Congress is deciding they want to set a floor on what those transparency requirements are, then we have leaned in to try and work with policy makers, because we believe in empowering all actors with the information that they need.

We also see some potential changes happening on the federal level around Medicare and Medicaid, and you always have to be very careful here, because anything that's done that may undermine our company's ability to negotiate down the cost of drugs, the net cost of drugs, to negotiate those discounts or rebates, that's going to have an impact on premium and cost for enrollees in those government programs. As long as Congress is aware of that and making an intentional choice, we also recognize that policy makers are the de facto clients when it comes to these government programs, and we do respect that principle, that the client is going to choose how they want to contract with the PBM and design their benefits.

Beyond that, we think it's hugely important, whether it's at the federal level or the state level, that any of these ideas that would interject the government into the contract between 2 entities in the private market are thought about really carefully, because once you start taking choice away and having Congress or other policy makers dictate the terms of contracts between 2 entities, then you're going to end up with a narrower set of options, fewer choices for employers, fewer options for controlling drug cost, and frankly, potentially a more monolithic-looking industry, because it will be harder for competitors to differentiate with different types of contract offerings. We've tried to make that point very strongly as we've engaged with policy makers.