Strategies for Improving Biosimilar Access and Utilization

In an interview, Elie Bahou, PharmD, senior vice president and system chief pharmacy officer at Providence, outlined key barriers to biosimilar adoption within integrated delivery networks (IDNs) and strategies to overcome them. He highlighted provider apprehension and operational hurdles, such as electronic medical record challenges, as significant obstacles.

Bahou also emphasized the importance of strategic payer collaborations, flexible contract terms, and patient and provider education to enhance access to high-cost biologics, reduce disparities, and improve adherence through clear communication of treatment benefits and outcomes.

This transcript has been lightly edited for clarity.

Transcript

What are the specific barriers to biosimilar adoption within IDNs, and how can IDNs incentivize physicians and pharmacists to prescribe biosimilars over originator biologics?

That's a good question. Doctors typically memorize 10 to 12 medications they're comfortable with. They like to prescribe them over and over. They have the names, they know the side effects, etc. So it's hard to break habits with doctors, as you can imagine. So I would say that provider apprehension or doctor/physician apprehension is there, and we need to educate them on the obstacles of implementing and switching, and the positive aspects of switching. The fact that they're similar drugs called biosimilars, and they save us sometimes 60% of the actual price [of the originator]. And then operational or technical barriers are also some of the challenges with respect to our EMR (electronic medical record) called Epic.

Even though a doctor prescribes a drug, if the payer, meaning the PBM (pharmacy benefit management) company, does not have that drug biologic on the formulary, they won't pay for it. So that's another complication. How do we mitigate that? We just engage the providers, as I said, to get them comfortable and make them understand the importance of these biologics. We work with the organizational P&T [pharmacy and therapeutics] committee to facilitate adoption of these biologics and to help guide [providers] on prescribing them.

Then, we use our clinical informatics team to ensure a seamless adoption of these biosimilars, and then we work closely with the manufacturers that make these biologics to bring additional value through contracting. So, those 4 ways are how we mitigate that.

What changes in pharmacy benefit design could lead to a more equitable balance between patient cost-sharing and access to high-cost biologic medications?

Good question. I think one of the best ways to do it is to just develop strategic partnerships with these drug manufacturers by negotiating pricing based on volume purchases, which is what they want, and on outcome. So that includes flexible type of contract terms that allows us to revisit the value and the volume more often to adjust according to market dynamics and payer coverage and then [we have more input with] engagement and policymakers and professional organization for policy type of advocacy.

So we have a whole government affairs team that really works very hard and lawyers and advocates that work in Washington, DC, to help us with that. And then, provider education—educate the health care providers in our system on the latest evidence-based type of practices to help them pick which biological that's more cost-effective to use for the best optimal outcomes. That's pretty much it. We educate our patients. We make sure that they are aware and understand what the therapy is used for, including potential benefits as well as side effects to enhance their adherence to their medication and their willingness to take it. That's pretty much it in a nutshell.