For Health Plans Developing Approaches to Biosimilars, Engagement is Key

While multiple stakeholder groups have roles to play in biosimilar acceptance and uptake, as more biosimilars reach the US marketplace, payers are becoming a particularly important group—one that is uniquely situated to engage with other stakeholders—in shaping the US biosimilars experience.

In an interview with The Center for Biosimilars^®, Mona Chitre, PharmD, CGP, chief pharmacy officer and vice president of clinical operations and health innovation at Excellus Blue Cross Blue Shield, said increased spending on specialty pharmacy products is a primary reason for health plans’ growing interest in developing strategies to address biosimilars.

Chitre explained that Excellus, like other plans, has seen a relatively small percentage of the population drive the trend toward increased spending on specialty drugs, and that spending is rising as specialty products are increasingly used to manage common diseases states with a higher prevalence. “Our goal is to ensure access and affordability of these medications to our patients, but these costs are becoming concerning,” she said.

Now that more biologics are coming off patent and biosimilars gain approval, “We have the opportunity now to introduce competition. It’s like generics of 20 years ago.”

Excellus, which Chitre notes was among the first plans to proactively address biosimilars, crafted a strategy for making the most of potential biosimilar savings that started with seeking out stakeholders’ views on and perceptions of biosimilars, then creating a plan to inform and educate each group.

Patients comprise a key part of that plan. Among non-clinicians, “the name biosimilar in itself can sometimes cause a little concern to a patient,” because the term implies that the patient’s treatment may not be the same. “It’s how we educate and overcome and inform,” said Chitre, that helps patients to gain a level of comfort with the idea of taking a biosimilar.

Among providers, Excellus found that, beyond the core needs for safety and efficacy data for biosimilars, a key issue for prescribers was the provision of equivalent copay matching programs and nursing services. Chitre said that prescribers’ emphasis on ensuring that nurses were informed about biosimilars spurred Excellus to engage with infusion nurses more closely, and that doing so was a “great opportunity” given how much interaction nurses have with patients who are undergoing treatment.

Finally, employers are a key group with whom Excellus engaged, and Chitre said that, after learning more about the potential savings that biosimilars can provide, some employers were willing to forego upfront savings in the form of rebates from brand-name drug sponsors in favor of long-term competition in the specialty drug market. “They bought in around the value of competition,” said Chitre. “It may take time, and it’s okay that we’re the first.”

Looking to the future, if biosimilars are successful, they could help provide headroom in pharmaceutical spending that will allow for new, even higher-cost therapies—such as gene or cell therapies—than products available in the market today.

“The way I think about it,” said Chitre, “is that maximizing generics gave us room for specialty,” and biosimilars could provide the much-needed room for spending on emerging treatments with even higher price tags.