Video
Biosimilar and Interchangeable Biosimilar Conversion Programs
Drs Atheer Kaddis and Mariam Alboustani delve into biosimilar conversion programs, including switching policies for interchangeability.
Atheer Kaddis, PharmD: We have been one of the national leaders in adopting biosimilars. We have a very extensive program, preferring biosimilars over reference brand products. To date, most of the biosimilars that have come to market have been infusion drugs, drugs that are paid for under the medical benefit rather than the pharmacy benefit. For every biosimilar that's come to market, we do have a program that prefers the biosimilars over the reference brand drugs. Our program has been able to shift around 90% of the market share, from the reference brand to the biosimilar, since we implemented the program.
In regard to new starts vs patients that are on current therapy and how we implement our biosimilars program, for most biosimilars, we require that the patients switch to the biosimilar—whether it's a new start or if they've been on therapy before. The only exceptions that we've made have been for oncology biosimilars. So, we've seen biosimilars for drugs like Avastin and Herceptin, and Rituxan. We've implemented a continuation of therapy program, or grandfathering program, where we notify the patient and their provider of the biosimilars program, but they do not have to switch to the biosimilar on day 1 when the program starts. We give about a 3-month timeframe for the physician and the patient to have more comfort in switching to the biosimilar. That's the only exception we've made in the oncology space. For all other biosimilars, whether you're a new start or you've been on therapy, the requirement is to switch to the biosimilar on day 1 when the program begins.
We've done a significant analysis on what impact a biosimilar program has on not only our spend but also on clinical results for patients. We get the clinical results through inquiries to our physician network. What we've seen with the biosimilars program is that we have achieved very significant net cost savings. That includes lower list prices on the biosimilars, as well as rebates, that we're receiving on the biosimilars. They’re significant savings over what we would have achieved in preferring the reference brands over the biosimilars. The feedback we're getting from our physician network is that the clinical results are very similar to what they would've expected with the reference brand. We're not seeing any downgrade or risk associated with switching to a biosimilar, in relation to lower clinical efficacy or safety concerns.
The interchangeability designation for biosimilars does make it easier for us to move market share from a reference brand to a biosimilar if we're preferring the biosimilar. The reason for that is with interchangeability, the prescriber does not have to write a new prescription for the biosimilar. A biosimilar can be substituted at the point of care or at the point of sale for the reference brand.
Mariam Alboustani, PharmD: Providers and payers can have an effect on patients in order to make them feel comfortable with switching or using an interchangeable or biosimilar product. I'll start first with addressing the provider. The provider is the patient's trusted advocate. Providers usually communicate with patients, and we've seen through experience that when a provider is agreeable to a certain treatment option, the patient also reflects that agreeability and is open to it. We've seen that if a provider is hesitant with a certain treatment pathway, the patient also is hesitant. The provider role starts as education, providing the facts. These products have gone through rigorous studies and have proven clinical efficacy. They are overall similar to the reference product. Also, the provider's role needs to be that of an open dialogue, in a way not to shy away from the other aspects of patients' concerns. “What are the differences?” That's an OK conversation to have between the provider and the patient. It is an educational role. Again, if the provider is comfortable with the treatment, the patient is going to have that same level of comfort. When we look at payers, payers have historically had a role in communicating with providers and patients. Payers have had patient-specific programs that have been designed to reach out to patients and speak about these treatments, as well as answer any of their concerns. They can also answer questions as to why a product is preferred on the formulary or not preferred. Communications have been either in writing letters to members or through telephonic outreach. The most important part is going to be educational and explaining the advantages of these products, and that should be the most effective way to communicate.
This transcript has been edited for clarity.
