Q&A: Challenges Health Systems May Face When Integrating Biosimilars
A conversation with Chelsee Jensen, PharmD, BCPS, director of formulary management at the Mayo Clinic.
Despite offering numerous benefits to patients, biosimilar adoption across various therapeutic areas has remained slow due to concerns over safety, efficacy and uncertainties about interchangeability.1 However, Chelsee Jensen, PharmD, BCPS, said that biosimilar utilization is key to reduce the overall cost of health care in the United States.
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Jensen, who is the director of formulary management at the Mayo Clinic, recently sat down with Drug Topics® to discuss key benefits of incorporating biosimilars into a health system's formulary, challenges health systems may face when integrating biosimilars, strategies health systems pharmacies can use to increase provider and patient confidence in biosimilars, and future trends in biosimilar development and utilization to prepare for.
READ MORE: Benefits of Incorporating Biosimilars Into Health System Formularies
Drug Topics: What are the key benefits of incorporating biosimilars into a health system’s formulary?
Chelsee Jensen, PharmD, BCPS: The key benefits are that we are able to save cost or reduce costs while not jeopardizing safety or efficacy. There also potentially might be margin improvement opportunities depending on your contracting and your payer mix. Overall, the main benefits of biosimilars are reducing costs while not jeopardizing anything.
Drug Topics: What challenges do health systems face when integrating biosimilars?
Jensen: I'd say conversions are always going to be the most challenging piece of incorporating biosimilars for a health system. Understanding what your payer mix is, whether they're requiring biosimilars or whether they're requiring the innovator product, is going to be important going into a conversion. Once you have that understanding of what your payers are requiring, then making sure you're working with a manufacturer to understand if they have adequate supply to support a large conversion. Patient and provider education are always very imperative, as well as ensuring that your providers are competent in using a biosimilar for a given disease state and what their plan is for educating the patient prior to integrating that biosimilar into their practice.
Making sure, more broadly, that your other involved care teams are aware of the transition. You might have to involve nursing—they're obviously the people who are administering and working the front line with the patients. Making sure they understand what the product change is, especially if there's potentially a different delivery device, those are important things to have awareness of and have some discussions on as you plan a conversion. Additionally, revenue cycle teams. If you convert when a product is still under a miscellaneous HCPCS [Healthcare Common Procedure Coding System] code, that can be disruptive, so the more communication you can have to some of those downstream teams is also important.
Drug Topics: What strategies can health system’s pharmacies use to increase provider and patient confidence in biosimilars?
Jensen: As far as confidence in general, looking to NCCN Compendia support—the National Comprehensive Cancer Network. Are they supporting biosimilars? Have these biosimilars been used in Europe for many years? What's their European experience? You can pull on some of that established literature where needed, especially if there's a confidence question or just a question on biosimilars in general. Otherwise, explaining the “why” to when you're undertaking a conversion. One, we're trying to achieve these cost savings. Two, maybe a contract expired, and we have a better value opportunity with moving to this biosimilar. Also, potentially, most of your payers that are coming here now require a biosimilar, so you are forced to make this change. Having that understanding and having that discussion on the front end is really important.
If you do have the potential to say, “Hey, this will change patients out of pocket costs and reduce them,” I think that's always beneficial to share with your providers. Because tiering structures with benefit plans are a little bit more complex, that can be a harder discussion to have, or a harder estimate to really narrow down. Active listening to the care team to identify what hesitation they might have is very important. Any barriers to conversion up front would be important. And, of course, leaning on FDA biosimilar education is really important. We have a ton of resources out there, so sharing that education is important as well.
Drug Topics: What future trends do you foresee in biosimilar development and utilization, and how can health systems prepare?
Jensen: I really do see for biosimilars, when they're available, that they will continue to be utilized. That's important to try to reduce the overall cost of healthcare in the United States. I will say that there are biologics out there that the patents have expired, and we don't have any biosimilar competitors entering the market. I would challenge health systems and manufacturers alike to really dive into what barriers there are. Where are the opportunities? How can we ignite and partner with industry to start developing biosimilars where there aren't any current competitors in the market? How do we as a health system potentially have a seat at that table to have some of those discussions, especially when we see a biologic that's heavily used in our health institution that's been used for a long time and for whatever reason, doesn't have competition? How do we facilitate some of those discussions with manufacturers to really bolster the biosimilar market in the United States?
READ MORE: Health System Pharmacy Resource Center
