By Jocelyn Collura, PharmD
Specialty pharmacy is a crucial link in the pharmaceutical supply and distribution chain, particularly for biologics and biosimilars covered under the pharmacy benefit. In this post, we asked a specialty pharmacy executive to discuss the ways in which organizations like her own contribute to the adoption of biosimilars.
The US biosimilar market continues to grow, providing significant cost-effective treatments for patients and plans. The shift towards direct specialty pharmacy collaboration versus a pharmacy benefit manager–rebate focus has been the missing element of biosimilar adoption thus far. Achieving the highest biosimilar conversion rate while maintaining patient satisfaction and minimizing therapy disruption is a balancing act. Formulary and cost considerations, collaboration amongst all healthcare providers involved with patient education, and accessibility of the tools needed for successful conversion are just a few of the primary components to achieve this balance.
The choice of an originator biologic versus a biosimilar or versus several biosimilars implies several strategic considerations. These include choosing an option covered by the plan, evaluating lowest out-of-pocket cost, manufacturer-pricing contracts, formulation availability or specialty pharmacy–developed provider tools (e.g., crosswalk and provider guides), and on-hand inventory immediately available for dispensing.
From the lens of a specialty pharmacy, our preference for a biosimilar product should be for the lowest net cost option, not a dual-pricing strategy. This allows a manufacturer to engage directly with a specialty pharmacy and suppliers, versus relying on rebates as a primary mechanism for obtaining coverage. It also promotes transparency in reporting for the health plan and employer groups; they will be able to determine exactly what they are paying for the pharmaceutical.
Patient access is another reason for specialty pharmacies to prefer a biosimilar with a lower net cost. Increased patient access can be facilitated with both formulary coverage and cash-pay/carve-out scenarios (in which case, the employer group wants to facilitate biosimilar adoption but the PBM favors products with a higher wholesale acquisition cost). Products in this pricing category will also be more favorable for patient coinsurance and lessen the out-of-pocket exposure.
Even within formulary restrictions, selection of a biosimilar isn’t a one-size-fits-all approach, and these factors need to be considered when prescribing. Much of the strategy behind selecting a biosimilar can be coordinated at the specialty pharmacy level. A successful biosimilar conversion involves guidance on product selection from the specialty pharmacy to the provider.
Specialty pharmacies often act as the liaison between the provider and patient. A seamless approach requires direct communication between all parties involved (specialty pharmacy, plan, provider, patient), the evidence-based knowledge to debunk any misconceptions on efficacy and safety, and confidence to relay all this to the patient to maintain patient centricity. Thus far, proactively working with providers, manufacturers, and plan sponsors in anticipation of a biosimilar launch has been a key component for success within smaller/local PBM and specialty pharmacies focused on lowest net cost. Initiating proactive communication in these areas ensures the path of least resistance is achieved to foster the best experience for the patient, while simultaneously lowering the cost of health care for the plan sponsor and patients’ out-of-pocket cost. This applies in all scenarios when transitioning patients to a biosimilar or specialty generic to ensure all parties are aligned, even if a product is interchangeable. The patient experience is always at the core of what we do. We believe that it is critical to educate patients to instill trust and empower them on their treatment journey.
In addition to the strategy for selection and collaboration amongst healthcare providers involved, the specialty pharmacy must have the tools needed to drive conversion rates. Knowledge of resources available for a specific product when working with patients is important to instill stability and trust. Patient assistance programs, replacement services for product issues, injection training and guides, and the ability to educate on any differences from the reference product on device/packaging are crucial. Having these tools available promotes confidence in the biosimilar and will ease the process of switching.
Biosimilar prevalence in the pharmaceutical world will continue to expand, influencing the market and decisions made by stakeholders. There is great potential for specialty pharmacies to influence high biosimilar conversion rates if paired with education and collaboration. As usage expands, improved comfort with biosimilars will allow for greater use of these cost-effective treatments for patients and plans.
Dr. Collura is Clinical Account Pharmacist at Reliance Rx, a national provider of specialty pharmaceuticals, servicing more than 20 health plans and over 105 total clients; providing access to 20+ million covered lives. Headquartered in Buffalo, New York, Reliance Rx offers national specialty pharmacy fulfillment and care coordination of complex disease states — resulting in greater efficiency, lower costs and improved services for our customers.
