Dr Bincy Abraham Discusses Working With Payers and Managing Biosimilar Options

Although multiple biosimilars may be available and on the market for an originator product, payer preferences may make it a challenge for providers to manage biosimilar options, explained Bincy Abraham, MD, professor of clinical medicine, distinguished professor and director of the Fondren Inflammatory Bowel Disease Program, and director of the gastroenterology and hepatology fellowship at Houston Methodist – Weill Cornell.

Bincy Abraham, MD

Image Credit: Houston Methodist

In an interview with The American Journal of Managed Care^® (AJMC^®), Abraham also discussed provider and patient education to improve uptake of biosimilars.

AJMC: When new biosimilars hit the market in new disease states, there's usually a slow ramp-up period for uptake. How can we help shorten that period and drive uptake faster?

Abraham: To providers, there may not be any options for improving that uptake, because we are driven by what the payers will have approved as a biologic for that patient. For example, if the originator biologic is what's on the formulary for that patient, then we're not going to be choosing a biosimilar for that specific patient.

On the other hand, if we had multiple options, and the providers are afraid about taking on or starting a new biosimilar, if it's related to data on efficacy or safety, I think it's educating providers on that information, so they feel comfortable in knowing that it's an FDA-approved biosimilar, which requires that the safety and efficacy have to be similar to the originator biologic.

AJMC: How do you handle patients who might be adamant about staying on the originator product and not switch to a biosimilar?

Abraham: If I have a patient who is pretty adamant about not switching to a biosimilar, I first find out why they're so adamant. Often, it's because they're afraid of making that switch, and their disease state goes into a flare. However, I can then provide them information on the safety of the medication, the efficacy, and how well the medications worked for patients who have been switched from biosimilar studies in that specific category.

The other thing I will also emphasize is that if I spend time trying to negotiate with the insurance companies to keep the patient on the originator biologic while it's no longer on the formulary or it requires them to fail the biosimilar, that it might actually delay the care of that patient. And I also have to emphasize that if I ended up having to delay the patient getting the medication, that could put them at the risk of the flare their disease, too.

So, I use the information from why they're adamant, and we'll relay that information to them by explaining that if they're concerned about their disease getting worse that the studies actually show no worsening of disease with switches. Or if they're concerned about costs, that's the other thing too, that if a biosimilar's required on the formulary, and the payer's mandating that switch, it will end up being similar cost or, in fact, maybe less expensive for that patient, as well. So, I can provide them the benefit of that switch.

AJMC: With multiple biosimilars on the market for some products, what are the challenges around managing various payer preferences for specific biosimilars?

Abraham: I really don't know what the payers are thinking I'm speaking from a provider's perspective. But if a payer chooses one biosimilar over the originator or specific ones, I assume it's related to less cost to them.

Now, if we have multiple options, how do I choose between those options? It ends up coming to a decision of what will be the fastest approval for that patient. Often, there may not be differences based on the different companies. I like to try to stay with a similar drug across this scheme of whichever originator it has been coming from, in the sense that if, let's say, I have multiple payers and one of the biosimilars is on the list for all of them, then it makes it easier for my medical staff to get approval because we know the steps for that specific company. And if it's going to be the same for different insurance companies as the same medication that we already know who the representative is for that medication, we can reach out to them specifically. They know how our office runs, they may have the same setup on getting approval, and so forth. So, it makes it easier rather than have 8 or 9 different biosimilars and 8 or 9 different methods of getting something approved and 8 or 9 different representatives that our medical staff have to work with, as well.

So, I try to stick with one, if at all possible, that's covered by majority of the insurances to make it easier and simplified for our office staff, as well.