August 1, 2024
Biosimilars continue to be a hot topic for plan sponsors throughout the nation. The potential for savings exists, but some of the challenges we discussed in a previous post continue to derail the uptake of these medications. So, what can plan sponsors do? Let’s look at four biosimilar strategy recommendations.
1. Prefer lowest cost at point-of-sale options
Choosing formulary options with high rebates can be appealing, but we recommend choosing biosimilars with the lowest cost at point of sale. Consider the following:
Rebates Will Be Lower
Opting for medications with low point-of-sale cost will mean that you receive a lower total rebate from your PBM. This may seem backwards at first, but it leads into the next point.
You Are Going to Save Money
While rebates go down, the checks you write to PBMs on a weekly, bi-weekly or monthly basis are going to be lower. This will lower overall costs.
Plan Members Will Save Money
Choosing the lowest point-of-sale cost also decreases costs for plan members. It slows the rate at which they hit their deductibles and out-of-pocket maximums.
So, how can plan sponsors tweak their biosimilar strategy to ensure the lowest cost at point of sale is preferred? Traditionally, plan sponsors have relied on PBMs to update their formulary choices to lower cost and navigate the alphabet soup of drug pricing. However, it is time to take a more active approach.
2. Find PBM partners with an aggressive biosimilar strategy
The graph below from IQVIA Institute demonstrates the potential savings this category can create. But there is a significant disparity between the low- and high-end of the savings range (shaded area).
What’s The Difference?
The key here is how tightly the biosimilar category is managed, and how aggressive your pharmacy benefit design is set up to promote biosimilars. Plan sponsors must either find a PBM partner that has an aggressive biosimilar strategy or consider customizing their formulary to drive biosimilar utilization.
What If My PBM is Not Aligned?
If you and your PBM have misaligned priorities on biosimilars, it might be time to look for a new PBM partner. As a fiduciary of your pharmacy benefit plan, it is critical to understand biosimilars and take ownership of decisions that impact the potential to create savings. Our team can help you find a PBM that aligns with your objectives. We can also help you customize your formulary to maximize savings potential.
3. Educate members about biosimilars and generics
Another critical component of biosimilar strategy is ongoing member education. Many people still have concerns about biosimilars. A study of US patients revealed the following attitudes about biosimilars.
Biosimilars have no clinically meaningful differences from their reference biological product. They have been studied extensively and are safe for use — that does not mean patients are comfortable with a biosimilar prescription. Education can bridge this gap.
How Can Plan Sponsors Execute Education?
Plan sponsors may lack the expertise and clinical knowledge to educate patients on the safety and efficacy of biosimilars. This is where a pharmacy benefits consultant with clinical pharmacists can step in and provide educational support.
Education can help plan members understand what biosimilars are and that there is nothing to fear. This can empower them to advocate for themselves and ask their provider to prescribe a biosimilar. Education can also help members better understand and utilize generic medications — further controlling costs.
Moving the needle on biosimilar utilization will have significant impact on realizing savings in this category. While a small percentage of a given population are eligible to use biosimilars (around 2% of scripts on average), they drive 46% of all pharmaceutical spending.
4. Educate Providers
Education cannot end with members. The chart below highlights the attitudes of just three medical specialties on biosimilars:
This data reveals that while physicians are more comfortable with biosimilars than patients, there is still a gap in knowledge that needs to be addressed. If a member’s provider is not comfortable with biosimilars, they will not prescribe them.
Pharmacy benefits consultants can support your efforts in this area. First, by providing education to providers. Secondly, by holding the PBM accountable to provide ongoing education to providers as well. Third, member education (mentioned above) can enhance these efforts. A provider is more likely to prescribe a biosimilar if an educated member advocates for themselves.
Next Steps for Plan Sponsors
The four recommendations in this post might seem overwhelming. But start small. Ask your PBM questions like:
- What is your biosimilar strategy?
- Are there any pricing or formulary choices plan sponsors need to make?
- Can you show me the math involved in your lowest net cost approach?
- How are you educating members and providers on biosimilars?
- How will you help us drive biosimilar utilization?
As always, our team of pharmacy benefit experts and clinical pharmacists can also help you analyze your PBM’s biosimilar strategy and help you set a course to maximize your savings potential. If you have any questions, don’t hesitate to reach out with the link below. And feel free to check out our in-depth biosimilar webinar.
