Managing Inventory Presents Unique New Challenge With Biosimilars

In an interview with Pharmacy Times at the 2023 Asembia Specialty Pharmacy Summit, Fran Gregory, PharmD, MBA, vice president of emerging therapies at Cardinal Health, said inventory management is particularly important and challenging with the emergence of biosimilars. She also discussed the differences between specialty pharmacy distribution and physician’s office distribution, and the benefits of each for patients.

Q: How does specialty pharmacy distribution differ from a physician’s office? What are the benefits of each for patients?

Fran Gregory, PharmD, MBA: Sure. So again, going back to those medical benefits, biosimilars are primarily in the oncology space, but again growing. We do see some immunology products in the medical space and we're seeing retina products or ophthalmology products in the medical space now as well. I think one of the benefits that patients see to using those medications is that they're there in the office and the physician or the nurse can administer that right then and there. They can explain the adverse events, can talk them through it, they can teach them sometimes how to inject or infuse on their own. Not typically in the case of oncology, but at times. You know, it's nice to have that one-on-one interaction with your health care provider. So that's kind of the medical benefit from a patient care perspective. The medical benefit from a reimbursement perspective is kind of the second piece of that, where physician’s offices need to be very savvy and smart about which biosimilars are priced out, what ASP or price that they're selling at currently, to make sure that they stay financially stable using the biosimilar. So that's kind of a different side of a biosimilar on the medical benefit that maybe isn't as apparent to a patient at the time that they're receiving the medication.

If we think about pharmacy benefits, biosimilars, and specialty pharmacies shipping those medications to patients, there are a lot of wonderful benefits that specialty pharmacies offer. Although they're telephonically speaking to a patient and counseling a patient, specialty pharmacies do a wonderful job of making sure the patients get their medication and they get it when they need it. [They] make sure that they don't miss therapeutic days or that they're not nonadherent to their medications. And they're wonderful at actually teaching patients how to use their medications over the phone. They can show them videos or help them understand things, and they have great clinical staff that is prepared to do that and educate patients. Another thing that I think specialty pharmacies do a great job of is helping patients financially. So, making sure that they can access multiple manufacturers or other funding for patients that might have financial barriers to obtaining their medication.

Q: What are some challenges of biosimilars for specialty pharmacies? How does it affect reimbursement?

Fran Gregory, PharmD, MBA: So, some of the challenges with specialty pharmacies managing biosimilars, there are several that I consider significant. One would be really the managing of the inventory. I've heard that many times from specialty pharmacies and providers on the medical benefit side, too, is that it's difficult to manage multiple inventories when they're all really the same drug, right? Essentially, the same drug. So, managing those inventories and trying to meet the demands of all of the different formularies. So, if you're a specialty pharmacy serving multiple formularies, you might have one patient that should have a certain biosimilar for one formulary and another one has a different one for another formulary. And managing all of those different biosimilars, I think, is a challenge for specialty pharmacies on the reimbursement side as well, making sure that the pharmacies just like providers are not financially challenged more so than they would be with the reference product.

As far as reimbursement and what they get paid from the payer or the PBM, those are some challenges as well. Really, only specialty pharmacies and payers and PBMs see those prices kind of behind the behind the wall there and know how to manage their financial situation. So that's something they need to take into account, as well. And then finally, I think the third challenge that specialty pharmacies might have would be just educating those patients and making sure that they're educated on biosimilars. So, I think that's a big area is for pharmacists to really make sure that they are up to date and they know their biosimilar landscape and portfolio so that they can help those patients understand the value and the benefit of taking the biosimilar medications.