Sonia Oskouei explores the managed care landscape and opportunities for increasing biosimilar uptake to improve patient care.
Sonia T. Oskouei, PharmD, BCMAS, DPLA: Overall, to have a successful biosimilars market in the United States, particularly in the immunology space and for products managed primarily under the pharmacy benefit, there are multiple considerations that need to come together to have successful adoption. I’ll start by focusing on the clinical component.
Clinical confidence is first and foremost the key to ensuring utilization and adoption of these products. When we talk about clinical confidence, it isn’t just from the lens of the prescriber or the physician. It’s all the stakeholders involved in a patient’s care journey: physicians; pharmacists, particularly with these agents; patients; caretakers; and even the managed care landscape, with payers and PBMs [pharmacy benefit managers]. All these stakeholders need to have comfort from a clinical standpoint and familiarity with these products, and therefore have confidence in the outcomes of utilizing these agents. The clinical part is key.
Integrated into all that is having enhanced education tailored to each stakeholder at the right level of translation, so it’s consumable and effective and provided at the right point of care. For example, with patients, [it’s important to have] patient engagement strategies around adherence and compliance, which often can be facilitated by pharmacists and pharmacies. All these are important to ensure a successful care journey.
Beyond clinical, adoption is heavily influenced in the United States by the managed care landscape. The financial picture needs to be viable and meaningful to have adoption of these biosimilars. When we talk about the financial picture, it isn’t for only 1 key stakeholder. It’s for PBMs and payers. Decisions made from a formulary standpoint could heavily influence the adoption or the ability to adopt these products when it impacts reimbursement and patient out-of-pocket costs. But even the savings to the overall health care system that healthy competition can bring also plays a meaningful role in having successful biosimilar utilization in the United States.
What’s needed to support or increase biosimilar adoption is strong understanding and implementation of even the regulatory considerations of biosimilars, meaning interchangeability. We’re seeing more activity with interchangeability designation, which is a designation made for pharmacists, so pharmacy-level substitution. With all sites of care that will be supporting this designation for patients who are being treated or getting product dispensed for adalimumab or other pharmacy benefit biologics, it’s important to make sure those stakeholders feel comfortable and well equipped with the knowledge, resources, and tools to successfully execute interchangeably designation. Not only from meeting state regulatory requirements, but making sure that they could also support patients along their care journey; understand what these products are, what the designations mean, and what is a regulatory designation in the United States; and support the overall utilization and experience with these biosimilars.
Transcript edited for clarity.
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