Rebates remain very attractive for many employers, but they should push back on the reliance on rebates that may be preventing biosimilars from being added to formularies, said Margaret Rehayem, vice president, National Alliance of Healthcare Purchaser Coalitions.
Rebates remain very attractive for many employers, but they should push back on the reliance on rebates that may be preventing biosimilars from being added to formularies, said Margaret Rehayem, vice president, National Alliance of Healthcare Purchaser Coalitions.
Transcript
Biosimilars are less expensive than the reference product, but there are rebates available for the reference. What is the thought process for employers when weighing the rebates offered vs switching to a biosimilar?
I know there's a lot that could go into the weeds on this particular conversation, because there's so many different dynamics that come up when you're talking about rebates. It's not a simple discussion for an employer to have. I think many employers are still highly influenced by the money that's offered with a rebate and many times will still move in that direction, because it's a simpler conversation. It's a simpler decision. But there are some employers that are starting to push back on rebates. We are actually encouraging employers to look at formularies that are, over time looking at reducing the reliance on rebates and really looking at drug value and looking at effectiveness and really making sure that their particular formulary has the right drugs that can get patients to the treatment that they need faster.
One other thing that I do want to add in is that we did this point-counterpoint with our employers around some of the things that they're told by PBMs [pharmacy benefit managers] as to why a biosimilar may not even be on formulary. Some of them are told that adopting biosimilars will result in a loss of rebates and a higher cost per employer. And that's not true. A lot of these drugs are out in the market that are FDA approved, and they can and should be on formulary.
Other than rebates, what other barriers do employers face that slow down the adoption of biosimilars?
I think that many times they're not being put on formulary at all. Employers are being told that they're not available. Or if they are put on formulary many times, they're put on a different tier, so the access level is not there. It really is a shell game. Depending on the employer, depending on the PBM that they're working with, the employer is not having a transparent conversation around how to be able to have access to biosimilars. Therefore, adoption is slowed.
The other thing is that some biosimilars will show up on the medical side. That brings in the carrier, the health plan. I think employers need to be better armed with what their PBM and their carrier is going to tell them about the efficacy of a biosimilar, around the availability about of the biosimilar, so they can make the proper decisions on what should be on formulary.
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
Bridging Care Gaps With a Systemwide Value-Based Care Strategy
March 29th 2025Mapping care management needs by defining patient populations and then stratifying them according to risk and their needs can help to spur the transformation of a siloed health care system into an integrated system that is able to better provide holistic, value-based care despite the many transitions that continue among hospital, primary, specialty, and community care environments.
Read More
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
Understanding Primary and Secondary Nonadherence to Chronic Oral Medication
March 28th 2025Medication nonadherence to oral anticoagulants and oral anti–prostate cancer medication has been scrutinized through new research conducted among patients and health care providers and presented by the American Medical Group Association at its 2025 annual meeting, held March 26-29 in Grapevine, Texas.
Read More
Bridging Education Gaps in Treatment for Scarring Alopecia With Innovative Approaches
March 28th 2025Crystal Aguh, MD, FAAD, Johns Hopkins School of Medicine faculty, highlights the critical need for comprehensive education on hair loss across diverse hair types, stressing the importance of understanding inflammatory pathways for developing targeted therapies.
Read More