Dr Jeremy Schafer Discusses Paying for Biosimilars and Patient Education

Although there are only 2 biosimilars approved in the United States, there is a great deal of excitement and speculation surrounding these treatments.

Jeremy Schafer, PharmD, MBA, vice president and director of specialty solutions at Precision For Value, discussed a number of important topics regarding biosimilars, including how he expects the US will have an easier time approving biosimilars and the importance of patient education about biosimilars.

AJMC: How are payers developing or deploying strategies based on evidence in terms of biosimilars?

JS: During my talk [at the AMCP Managed Care & Specialty Pharmacy Annual Meeting] I’m going to be talking a lot about survey data that Precision for Value did with a lot payers. We have a large payer panel that we consult with regularly and from a payer strategy perspective they’re very interested, they’re very excited about biosimilars. I mean, naturally, these are categories that have been resulting in a lot spend for quite some time and they’re looking for relief there.

So I think it depends on the benefit, but they’re certainly looking for agents that have the same efficacy but whatever’s going to be the lowest net cost. So that doesn’t necessarily mean it’s going to be the biosimilar, but it’s going to be one or the other between the biosimilar brands. And I think in the pharmacy benefit will price the fair amount of step therapy and preferred product ways as well as including the specialty pharmacy and doing interchanging of products for preferred product.

On the medical benefit it’s naturally going to be a little bit different, but our panels have indicated that medical policy differentials in reimbursement and, even up to and including capitated agreements with providers, to encourage low cost therapies are all on the table.

AJMC: Do you think that the United States will have a clear path in terms of biosimilar approvals going forward?

JS: I think so. I think that right now there’s kind of a backlog at the FDA just because there’s so many applications coming in—which I think is encouraging for the market. But I think that the more they get accustomed to it and used to the idea, the more we’ll see the biosimilar process become smoother and the players become more used to it.

So I certainly think that it’s going to smooth out and given how they reacted to the biosimilar infliximab by granting extrapolation and strong support, that tells me the FDA is at least in that application getting the information they want.

AJMC: There are concerns that biosimilars might not be significantly cheaper than the innovator products. What are your thoughts on that?

JS: Now this is something I’m going to be talking about during my session, as well as something that we polled our payer panels on.

I think one of the things to keep in mind is that “significantly” is going to be different depending on the audience. I mean, some of the payers that we talked to said they’re not going to budge until it’s at least a 30% drop, whereas some said that 10% to 20% is fine with them. So I think that what we’ll probably see is that I think there’s going to be probably stronger reductions than people think and simply because as the market becomes more competitive and more players enter it that’s what’s going to happen, and we certainly have seen that in several countries in Europe where there’s been some pretty drastic discounting.

Now that doesn’t guarantee that the same thing will happen in the United States, but I think that there are categories out there right now like growth hormone and even in the immunoglobulin space that have shown that payers or health systems or whoever, when in a competitive marketplace, can drive cost down pretty far.

AJMC: Do you think that there’s a need for patient education on biosimilars?

JS: Absolutely. I think that biosimilars are a new concept to patients, I think they’re curious about them, but right now there’s not a lot that they know about them. And I think it’s particularly important for some of the outpatient medications that patients may be receiving at the pharmacy. Because it’s one thing if you’re being on Remicade for years, but you’re going to an infusion center, and you’re switched over by your doctor and right there at the infusion center that probably is going to be perceived differently than if you’ve been getting, say, Enbrel for years at your specialty pharmacy, and then you get a biosimilar instead.

But I think there’s a lot of stakeholders that will be involved in that education from providers to health systems to, in particular, specialty pharmacies.

AJMC: Have you seen any programs around patient education yet or nothing specific?

JS: Nothing too specific, and we do a lot of patient education work with our clients and find that there’s a lot of interest in it, particularly in the biosimilar space, so I think that I expect this kind of thing to ramp up quite a bit. Especially when you start to see biosimilars getting released that are on the pharmacy side, where patients are getting them directly versus, you know, when you think of something like the G-CSF agents where we’ve seen a biosimilar already, a lot of that is more the provider system angle. So the patient message becomes not as important, but I think it’s going to ramp up as we get more self-injects and pharmacy benefit products.