While commercial payers have been engaged with the shift to biosimilars, they all have their own preferred biosimilar, which makes it challenging for practices, explained Lalan Wilfong, MD, vice president of payer relations & practice transformation at The US Oncology Network.
While commercial payers have been engaged with the shift to biosimilars, they all have their own preferred biosimilar, which makes it challenging for practices, explained Lalan Wilfong, MD, vice president of Payer Relations & Practice Transformation at The US Oncology Network.
Transcript
What has been your experience with commercial payer contracts on the use of biosimilars? Are they encouraging biosimilar use?
In our experience, commercial payers are wanting to move to biosimilars. Many of them—because of what they do and having to be held accountable to their employers and other people who are buying services from the insurers—they do want to utilize services that lower the cost of care. We have seen a shift to biosimilars for our commercial payers.
I’ll say the challenge with them is that each one of them want to pick a winner that they like, which makes it extremely challenging for a practice to have to shift gears for every patient that walks in the door and use the insurer’s “preferred biosimilar” versvsus just using biosimilars. And we always advocate for physician choice and that if we're going to use biosimilars, let us be able to pick the biosimilar that we want to use so it's much easier on a practice to be able to manage their patient population, rather than having to switch gears with every single patient that walks in the door.
5 Key Health Care Moments During President Trump's First Month Back in Office
February 21st 2025President Donald J. Trump pushed for significant health care changes during his first month back in office, through executive orders affecting managed care, drug pricing, and clinical trial diversity guidance.
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
NSCLC Advancements Offer Hope, but Disparities Persist
February 20th 2025Ioana Bonta, MD, Georgia Cancer Specialists, discusses the evolving state of non-small cell lung cancer (NSCLC) treatments, their impact on patient outcomes, and the need to address ongoing disparities in these populations.
Read More
Adapting ACA Access Amid Medicaid Transition and Policy Reversals: Molly Dean
February 19th 2025As enrollment shifts to the Affordable Care Act (ACA) marketplace following the unwinding of Medicaid and the Trump administration begins to implement health policy changes, Molly Dean, MSW, Siftwell's policy advisor, shares insight on how to adapt.
Read More