Biosimilars are a wonderful option for patients, but the growing number available can be challenging to manage when different payers prefer different agents, said Susan Sabo-Wagner, MSN, RN, OCN, executive director of clinical strategy for Oncology Consultants of Houston, Texas.
Biosimilars provide more options for patients and savings for practices, but payer preferences can be challenging to manage, said Susan Sabo-Wagner, MSN, RN, OCN, executive director of clinical strategy for Oncology Consultants of Houston, Texas.
Transcript
Can you speak to the role of biosimilars in helping patients with cancer with drug costs?
Because it's a diverse payer population in our practice, we use quite a few biosimilars. Because we have payers preferring [certain biosimilars]. Of course, we have our own preference of biosimilars, that our contracts are better, but then they have their own as well. I think there's definitely savings with it. Where we would prefer it, is like I said, we have our own preferences in each category, because it's more cost savings for us, which then of course can be passed on. But then of course, each payer has their own as well.
I think that biosimilars are a wonderful option. It does get quite confusing when we have a million in each family out there, but it's certainly something that is a wonderful option to have. The way that they're marketing it straight to payers is an interesting avenue. That's why they get their own preferences. We're all kind of figuring out.
Last year—it’s not as bad this year—they were changing quarterly almost. It was for one quarter, Aetna—and I'm just using Aetna as an example; not necessarily them—but “this is our preference,” then the next quarter “Oh, this is our preference.” That just came from direct marketing to each payer. I guess they got in the groove a little bit better for this year. It wasn't as much of a crazy jumping around.
It's definitely a good thing. I think it was about time that we had some ease for patients. It would be just nice if we could stop making them so much. There is a lot of competition now in some of the markets.
Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care
February 25th 2025On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
Listen
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
Listen
More than 5 years after the American Society of Clinical Oncology warned of emerging disparities in precision medicine, efforts by community practices to embrace technology, form partnerships, and use data show how patients can gain access to personalized approaches. But challenges remain, especially for those covered by Medicaid.
Read More