Streamlining Biosimilar Access: How EHR Automation Transforms Patient Care

In an interview, Sarah Hudson-DiSalle, PharmD, RPh, FACCC, pharmacy manager at The Ohio State University Comprehensive Cancer Center – The James and The Ohio State University Wexler Cancer Center, highlighted how automating biosimilar selection through electronic health records (EHRs) significantly improves patient access to affordable treatments.

She noted that biosimilars reduce patient out-of-pocket costs and streamline processes for health care teams. During a pilot program, automation in favor of biosimilars reduced the average time to treatment approval from 12 days to 4 days, enhancing efficiency for pharmacists, providers, and authorization teams. However, she also emphasized the challenges of payer alignment, insurance accuracy, and timely updates, which can impact the effectiveness of automated systems.

Transcript

How could automating biosimilar selection through the EHR improve patient access to more affordable treatments?

So, we know with biosimilars the first thing is decreased costs. And with that, we have seen patients have decreased out-of-pocket expenses. There's also assistance that helps these folks pay their coinsurances or their co-pays. But really having that percentage, and many of the plans have a percentage out-of-pocket [costs]. The use of a biosimilar with the decreased cost has just less expenses for our patients.

So as I said before, we saw a decrease in our initial pilot from 12 days to 4 days. When your staff kind of comes to you in the middle of the pilot and says, "When can we turn this on for the other agents?" It was an overwhelming response from our team that said, "This really is more efficient for us. We had less time that our specially practiced pharmacists were making changes for interchangeability, less time for our providers. And then, also, we were getting patients into the chair much quicker."

So the authorization team really found a lot of benefit in having that information that comes to them. And you can also see that if the insurance in the [EHR] is not entered in correctly. Let's say the patient's secondary [insurance] is entered in as the primary insurance so the wrong biosimilar is picked, I hear about it. So, I hear about the things that maybe don't go right but when your team says, "Hey, I want this to work properly," I think it speaks volumes.

And one of the barriers that does occur is depending on how many payers that the system might have, or the practice might have—The James has a large payer mix, and so initially we have 25 payers that we used in this model—if you don't have alignment, or your advanced order group is not aligned with the payer's biosimilar, it can then have some downstream implications that occur with that. Or if the patient's insurance isn't updated appropriately in that time, you could have the tool picking the wrong insurance's biosimilar. That's probably where we have seen the advanced order group fail. And then updates sometimes too. It just takes a little bit of time to make sure that those updates [are done]. Those are human steps that we have to incorporate. I wish we could say, if we know when the biosimilar has changed, that would be an immediate evaluation from our finance team. It just takes a little time.