Expert: Pharmacy, Medical Benefit Adoption of Biosimilars Present Different Challenges

In an interview with Pharmacy Times at the 2023 Asembia Summit, Fran Gregory, PharmD, MBA, vice president of Emerging Therapies at Cardinal Health, discussed the biosimilars landscape and where biosimilars fall in the process of pharmacy and medical benefit adoption. Pharmacists play a key role in educating patients and other clinicians about the value and importance of biosimilars, Gregory said.

Q: The biosimilar industry is a growing topic among health care providers. How does the pharmacy adoption and medical benefit adoption of biosimilars differ?

Fran Gregory, PharmD, MBA: Yeah, sure. So, the medical benefit biosimilars have been traditionally the first biosimilars that we saw come to market, the first one being in 2015. So, that was a Neupogen biosimilar which was considered a supportive oncology care molecule. And [with] that particular biosimilar we saw actually pretty decent uptake pretty quickly. It was probably the first biosimilar and the only biosimilar that we saw ramp up so quickly. Since then, the oncology biosimilars have been in supportive care as well as therapeutic areas, so therapeutic areas and oncology were a little slower to accelerate. However, with the Oncology Care Model and with some reimbursement changes that were made by CMS, we did see an uptake of therapeutic oncology biosimilars on the medical benefit as well.

So, when you think about medical benefit biosimilars, a lot of people naturally associate those with oncology just because that's kind of where biosimilars started in the US and that's where we've seen the most rapid uptake. So, oncologists are very attuned to using biosimilars and most oncologists are very familiar and comfortable with them, as are our patients now within the oncology setting. If we think about moving into the pharmacy benefit biosimilars, that's where we're starting to see the insulins, and we're seeing now the adalimumab or the Humira biosimilar that everyone is raving about. So, if we think about the pharmacy benefit biosimilars, these are newer therapeutic areas for biosimilars to emerge in. Some of these providers aren't quite as familiar with biosimilars yet so there'll be a few different things that we'll need to see happen on the pharmacy benefit side for these biosimilars to really see an uptake. And those are things like educating providers, educating physicians, making sure those physicians are educating their patients. And also, the pharmacists will play a huge role in pharmacy benefit biosimilars, and that's mainly because the pharmacies will be dispensing these medications, versus on the medical benefit, those physicians were really dispensing those medicines and administering them.

So, when we think about pharmacists playing a role here, the key—or kind of one of the keys, there are many keys to unlock biosimilars on the pharmacy benefit—but one of those is really the pharmacist educating the patient about that biosimilar, making sure they're comfortable with a biosimilar, what it is, how it works, that it's the same, that they'll see the same clinical benefit, and it's okay to switch. So that's another topic, switching and interchangeability, but it's okay to switch and pharmacists will really play a critical role in educating patients about that. It's okay to switch to a biosimilar.

The second thing on the pharmacy benefit side is going to be reimbursement and formularies. Formularies take place on both the medical and the pharmacy benefit. However, on the pharmacy benefit, they're much easier in real time for PBMs and payers to manage those formularies. So, the formularies or the selections of the preferred biosimilar products will be very directed by the PBMs and payers. So, the pharmacist will need to ensure that they have the biosimilars in stock, that they have adequate inventory, that they ensure accuracy and dispensing the correct one. And managing all of that is a lot, right? Pharmacies, even specialty pharmacies, are not necessarily used to stocking 10 different versions of essentially the same product. So, making sure that, in the insulin world, retail pharmacies primarily [carry] adalimumab. In the rheumatology world, it will be primarily specialty pharmacies. So, making sure all of those pharmacists, regardless of the setting, are prepared and educated and understand the value of biosimilars and essentially that those patients understand the value as well.