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Optimizing the Implementation of Biosimilars Into Formularies

Opinion
Video

Panelists discuss how health systems can learn from published case examples when implementing biosimilars, noting that biosimilars can create a “win-win” situation where patients see lower costs, payers see lower charges, and providers may experience better margins.

Health System Implementation and Pricing Strategies

Key Themes:

  • Learning from Experience: Health systems can learn from published literature on biosimilar implementation, including European experiences where products have been available for longer periods.
  • Pricing Structure Considerations: The industry is shifting from high wholesale acquisition cost (WAC) with large rebates toward lower upfront pricing models in response to public pressure for transparency and reduced pharmaceutical costs.
  • 340B Program Benefits: Biosimilar manufacturers typically extend 340B discounts where originator products might have protections, creating additional savings opportunities for eligible sites.

Key Points for Physicians:

  • Learning from published implementation experiences prevents repeating mistakes and streamlines adoption.
  • Beyond direct acquisition costs, consider additional financial benefits such as 340B program eligibility when evaluating biosimilars.
  • Biosimilars can create “win-win” scenarios with lower patient costs, reduced payer charges, and potentially improved provider margins.

Notable Insights:

The industry trend toward low WAC pricing reflects growing criticism of inflated list prices with large rebates, leading to more transparent pricing models.

Clinical Significance: Biosimilar implementation offers multifaceted financial benefits beyond simple acquisition cost savings, including program eligibility considerations and value optimization across the care continuum.

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