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Payers and PBMs Impacted by Biosimilar Integration
Alice B. Gottlieb, MD, PhD, leads a discussion highlighting biosimilar utilization impact on payers and pharmacy benefit managers (PBMs).
EP: 1.Utilizing Recently Approved Biosimilars in Clinical Practice
EP: 2.Transitioning to Biosimilars: Considerations for Providers and Payers
EP: 3.Navigating Challenges Associated with Biosimilars Across Various Disease States
EP: 4.Provider Acceptance Driving Confidence in Biosimilar Therapy
EP: 5.Decision-Making Process Surrounding Biosimilar Implementation
EP: 6.Biosimilar Administration Considerations Impacting Patient Experience
EP: 7.Initiating Biosimilar Treatment in Patients Without Previous Reference Biologic Experience
EP: 8.Switching Patients from Reference Product to Biosimilar
EP: 9.Defining Interchangeability and Switching in Biologics
EP: 10.Evolution of Auto-Substitution in Biosimilar Landscape
EP: 11.An Overview of Biosimilar Extrapolation During FDA Approval
EP: 12.Harnessing Indication-Specific Data on Biosimilars
EP: 13.Cost Savings Related to Biosimilars
EP: 14.Payers and PBMs Impacted by Biosimilar Integration
EP: 15.Payer Support Driving Lowering of Biosimilar-Related Health Care Costs
EP: 16.Patient Conversations: Managing Patient Expectations Regarding Biosimilars
EP: 17.Key Points of Emphasis Regarding Biosimilar Integration
This is a video synopsis/summary of a panel discussion involving Ryan Haumschild, PharmD, MS, MBA; Alice B. Gottlieb, MD, PhD; Bincy Abraham, MD, MS; Jamie T. Brogan, APRN; and Vibeke Strand, MD.
Haumschild asks Gottlieb about her experience with payer and pharmacy benefit manager (PBM) coverage of adalimumab (Humira) biosimilars.
Gottlieb says payers and PBMs have almost 100% influence over options. She has no experience yet with adalimumab biosimilars, though they are formulating policies. With infliximab and rituximab biosimilars, use is 100% mandated by the hospital with no branded options. She urged payers and PBMs to ensure lower patient costs and increased access, especially for Medicare patients.
Abraham says payer coverage influences prescribing. If multiple adalimumab biosimilar options are covered, she would choose based on factors like citrate-free formulation, available doses for induction/maintenance, indication-specific data, patient co-pay assistance, and ease of access/prior authorization. It is still early to judge current payer flexibility.
Video synopsis is AI-generated and reviewed by AJMCÒ editorial staff.
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