Study: Payers Play Wait-and-See Game of Biosimilar Preference

Most payers tend to adopt a “wait and see” approach to promoting biosimilar switching strategies among providers, according to a focus group study.

The approach calls for watching what other payers do rather than initiating switching incentives via policy requirements, according to payers who participated in the study.

However, the payers agreed that getting providers to switch to a new biosimilar requires careful market preparation that targets physicians, health systems, pharmacists, and patients.

“Discussions with network physicians about a biosimilar switch started several months before the formulary change to reach mutual agreement across stakeholders,” according to one payer participant cited in the survey.

Physicians were given educational materials about safety, efficacy, and potential cost savings, and pharmacists and patients were called by phone and notified about the coming biosimilar switch.

There was also a 90-day prior notification of the formulary change and, authors of the study said, the prior authorization process was removed or accelerated. With these targeted initiatives, the payer group was able to reach a 90% biosimilar adoption rate among its patients.

Expediting prior authorizations was, in fact, a top recommendation of providers who participated in surveys that provided the basis for the focus group discussion. Authors said 80% of participating physicians felt expediting prior authorizations would simplify access to biosimilars and result in an uptick in biosimilar usage; 69% of managed care pharmacists (MCPs) concurred with this viewpoint.

The focus group panel consisted of 5 MCPs and 3 physician experts in rheumatology, dermatology, and gastroenterology from large managed care organizations and health care systems in the Boston region.

Two surveys involving 300 managed care and specialty pharmacy professionals and 48 providers served to inform the focus group discussion. The surveys were conducted by PRIME Education and the Academy of Managed Care Pharmacy.

Prior Authorization

“The panel agreed that removing administrative burden from prior authorization requirements was necessary to increase biosimilar adoption,” authors of the report said. Other means of incentivizing biosimilar uptake also were discussed.

The authors cited a recent study of Medicare formulary placement, which showed prescription drug plans tend to place biosimilars and their reference products on the same cost-sharing tiers and require prior authorization at the same frequency, “providing little incentive for biosimilar adoption.”

More communication with payers is essential to facilitate biosimilar adoption, the focus panel concluded. This includes transparent pricing information about formulary placement and biosimilar pricing, along with point-of-care information on cost savings.

“These strategies could drive provider’s willingness to prescribe biosimilars and support conversations with patients about biosimilar switches,” the authors wrote. Cost-benefit transparency would also boost trust among providers, payers, and patients, they said.

Need for Evidence

Other strategies for biosimilar adoption that scored high on the approval tree among providers and MCPs were educational programs for prescribers that focused on evidence for switching to biosimilars (MCPs, 91%; providers, 92%) and educational programs covering real-world evidence from postmarketing studies, including in the European Union (MCPs, 86%; providers, 88%).

“For biosimilars, postmarketing surveillance studies are pivotal in establishing the safety, efficacy, and immunogenicity profile compared with the reference product,” the authors wrote. For example, the NOR-SWITCH study of patients with immune-mediated inflammatory diseases has been of great value because it demonstrated the noninferiority of switching from originator infliximab to its biosimilar compared with remaining on the originator product, they wrote.

Although physicians ought to be reassured by confirmatory surveillance studies and long-term real-world safety data, surveys suggest physicians’ biosimilar prescribing confidence remains low, the authors said. “At the focus group meeting, there was consensus regarding the substantial need for provider education about biosimilar use in clinical practice.”

Providers who participated in the focus group said biosimilar education would be best delivered by clinical pharmacists from the same institutions as providers. They said this education should be provided in grand round or small group presentations, and they recommended that it be tailored to physician specialties with clinical data provided for each disease condition.

Another means of incentivizing the use of biosimilars that survey participants strongly favored was adjusting fee schedules for biosimilars (MCPs, 68%; providers, 62%) and reducing cost sharing for patients using biosimilars (MCPs, 80%; providers, 79%).

“In fact, focus group providers believed that switching to biosimilars should be associated with tangible benefits to their practices [eg, higher reimbursement, money for additional staff hires] and patients,” the authors wrote.

“These steps require ongoing collaborative initiatives among multiple stakeholders to optimize use of biosimilars,” they concluded.