Commentary
Video
Adoption barriers include insurance coverage, patient and provider education, and regulatory hurdles that require aligned initiatives across stakeholders.
Biosimilars present a significant opportunity to drive down health care costs, with Amanuel Kehasse, PharmD, PhD, director of clinical programs and drug information at Clearway Health, noting they are priced at least 25% to 30% lower than reference biologic products. This pricing discount allows pharmacies to stock multiple biosimilar options, easing budget constraints for health systems. However, several key barriers impede widespread biosimilar adoption. Insurance coverage is a major hurdle, as patients lack access if biosimilars are not included in formularies or designated as non-preferred. Addressing patient and provider knowledge gaps and misconceptions about biosimilars is also crucial, as physician hesitancy to switch stable patients to biosimilars remains a concern. Regulatory and policy changes are needed as well, such as easing development process restrictions and ensuring payment parity.
Pharmacy Times: What is the potential cost-saving benefits of biosimilar coverage and reimbursement for pharmacists?
Amanuel Kehasse: This is a multifaceted one, and it's very complex to break it down to the patient level. But in general terms, biosimilars are priced at least 25% to 30% lower than the reference product, so that you have that percentage discount in pricing. But in terms of pharmacies, the budget issue is key because if they are lower cost, if they have a lower cost of acquisition, the pharmacist will have a significant power to have multiple medications on stock so they can actually treat multiple patients within the certain budget. It will ease up the budget constraints of health systems. But more importantly, as we adopt biosimilars, indirectly, it will drive down the price of the reference product as well. So indirectly, you're actually contributing to the lower cost of the reference product. At the patient level. There will be multiple opportunities to have a cost saving. It could be lowering the copy of the patient, lowering the co insurance, or maybe lowering the premium. But in general, when you lower the total health care cost, it would allow for more equitable access to biologics to a diverse patient population who otherwise will not be able to access biologic therapies.
Pharmacy Times: What are the barriers to patient access to biosimilars, and how can we overcome them?
Amanuel Kehasse: So the key barriers to patients to access biosimilars are insurance coverage. So if insurance are not adopting these biosimilars into their formulary, patients will not have access or, even if insurance adopted this one into their formularies, if they're designated as non-preferred alternatives, and that makes it harder for patients to access this medication. But more, importantly, also the patient themselves are key factors here as well, the gap in knowledge that they have, or the perception or the misconception that they have on biosimilars need to be addressed for them to access it. Physician hesitancy to prescribe biosimilars or switch patients from a reference product to biosimilars in either key factor. For example, a lot of physicians are hesitant to switch biosimilar for stable patients. We call it a non-medical switch to biosimilars when your patient is stable in the current medication. Switching them to biosimilar is a key concern for them, because their patients doing well, they don't want to risk any disease flares. So all these things should be addressed and but the key is education, education, and education to both providers and patients, and also make sure that the policy that are being a hurdle in terms of payment parity, when you're dealing with biosimilars, and some incentives as well, for the patient and for the for the for the health system, for them to adopt biosimilars into practice will be required.
Pharmacy Times: Is there anything else you would like to add?
Amanuel Kehasse: Biosimilars are here to stay, and the number of biosimilars that have been approved in the market are increasing, but the cost saving opportunity that we can realize from this one is only if we adopt them right. If they're in the market, nobody is using them, the cost saving opportunity may not be realized. So we need to make sure that we ease up the development process restrictions that they have on biosimilar, for example, the interchangeability clinical trial design for forcing manufacturers to do multiple clinical trial that will increase the cost of production of that molecule, and patient education to make sure that they are comfortable to use biosimilars. Physician education to make sure that they're comfortable to use biosimilar for their patients, and insurance and other policy stakeholders also need to make sure that they align their initiatives, to make sure that they support the biosimilar development and adoption into the clinical market, and make sure that they're sustainable once they're adopted.