Dr Leslie Fish on Future Biosimilar Trends in Managed Care Pharmacy

Leslie Fish, PharmD, senior vice president of pharmacy at IDP Analytics, LLC, explores the future trends of managed care pharmacy practices, specifically through biosimilars. Leslie Fish presented a session at the Academy of Managed Care Pharmacy (AMCP) 2024 annual meeting, titled "Drug Pipeline: Traditional Pharmaceuticals (Brands and Generics)," where she addressed up and coming drug release dates, costs impacted, and pharmacy and therapeutics committee practices.

In her role at IDP Analytics, Fish is the leader of a team of pharmacists who develop and maintain medication management. She works alongside the company to promote quality care and cost-effective drug utilization.

Transcript

In your view, what are the most significant trends you expect to see in the next 5-10 years that will have the biggest impact on managed care pharmacy practices?

First of all, I think this new Medicare IRA [Inflation Reduction Act], [for] CMS, is going to have quite the impact on all of health care, because although we're not talking commercial and maybe Medicaid, it will flow down to those areas and it will touch it. So what is happening in pharmaceutical pricing, drug negotiation, drug spend will certainly, although it's in Medicare right now, where everything is happening, it will begin to touch the commercial and it will cause an effect on the commercial and Medicaid and all the other plans. I think that's actually one of the biggest things and we really do have to wait until 2025, 2026, 2027 to see what happens.

A little bit about the history of biosimilars, because I think this is quite interesting. When biosimilars started, which was 9 years ago, it was in the filgrastim market, Neupogen was the first biosimilar to go and it's been 9 years. Originally, we were pretty excited about it and it did not come out with a great price or a price that we thought. The first biosimilar came out at only around 85% of the branded, so around 15% less. We had expected it to be much more, and because of that it didn't get a lot of traction at the beginning. However, the companies actually started to rebate. So their idea, that biosimilar companies themselves, started [saying] we'll come up high and then we'll rebate down like a branded drug.

The prices did come down, it did take off, and then in an area that I actually work in, oncology, when those medical medications came out, so our member medical benefit, they took off. Avastin [bevacizumab], Herceptin [trastuzumab], Rituxan [rituximab], those biosimilars took off, so that was on the medical pharmacy, the medical benefit side.

Let's switch over a little bit to now what's happening—and this is what I think we're going to be waiting and seeing in the biosimilars—because we have gone from the medical benefit, which again, are a lot of the medications that I have worked in in oncology, and now we're going over to the pharmacy benefit and that's your Humira and adalimumab; Stelara [ustekinumab] is going to be the next one.

I think this week, we just had the second biosimilar approved, we could be seeing them and now in 2025. So it's going to be a little bit more maybe slow. We may go back to what the first biosimilars on the medical side looked like, it did not take off this year or in 2023 as much as we thought it would. However, I do believe that the biosimilars coming up in multiple sclerosis, more so in the immunology spaces, that's going to have a large effect on health care and on drug pricing.