Innovator biologic drugs have become important treatment options for complex, chronic disease states, such as autoimmune conditions, diabetes, and cancer. While the use of biologics has had a measurable impact on patient outcomes, biologics come with a high price tag and often represent top hospital and health system expenditures.
The expanding use of these expensive biologics is creating unsustainable financial situations for many hospitals and health systems and has given rise to the development of biosimilar drugs. Biosimilars work similarly to original innovator biologics but are less expensive and deliver no clinically meaningful difference.
In 2015, the Food and Drug Administration (FDA) approved filgrastim – the first biosimilar. Since then, an increasing number of biosimilars have been approved. Though biosimilars help reduce the cost of care, the administration of and reimbursement for biosimilars present complex challenges, including, but not limited to payer issues.
What Are Biosimilars?
Unlike traditional pharmaceutical drugs – where a less expensive generic version is an exact molecular replica of the original brand-name drug – biosimilars are not chemically identical to the original innovator biologics. The molecular structure of the original is too large and complex to replicate.
As defined by the FDA, biosimilars are “highly similar” to the original innovator biologic and have no clinically meaningful differences compared to the original biologic therapy. Biosimilars are just as safe and effective as the original innovator product. However, while a pharmacist can substitute a generic non-biologic treatment for a brand name non-biologic, the same does not hold true for biosimilars and original innovator products – at least not yet.
Benefits of Biosimilars
The key advantage of utilizing biosimilars is reduced costs to both the healthcare system and patients. Biosimilars provide an opportunity for hospitals and health systems to lower their costs of providing care without lowering their quality of care. For
patients, biosimilars often require a lower out-of-pocket cost when compared to the original innovator biologic.
Some providers have been reluctant to adopt biosimilars into their practice because payers often dictate which biosimilars they will pay for. This makes it difficult for hospitals and health systems to manage multiple versions of the biosimilar to meet payers’ reimbursement requirements.
Because of the complex payer network issues associated with biosimilars, providers often end up paying approximately double the price for the original innovator biologic.
Deploying an Effective Biosimilar Strategy
Comprehensive Pharmacy Services, LLC (CPS) delivers clinical expertise and effective biosimilar strategies to meet payer demands while reducing the cost of care.
- Analyze situation and ensure provider buy-in
- Review payer reimbursement
- Adjust payer reimbursement data monthly
CPS teams are often able to cut the cost of three of the top ten most expensive products that a hospital uses by 50 percent while increasing the margin the organization receives. Establishing a biosimilar strategy results in paying less for a product. Identifying a preferred payer product for therapeutic use helps preserve the service line. This can be critical in a community area, for example, where supporting a cancer clinic may be difficult.
To date, CPS has rolled out initiatives for the following biosimilars and exceeds the national benchmark by at least two times for their uptake:
Through effective biosimilar strategies, CPS helps providers reduce the cost of some of their most expensive products while ensuring high-quality patient care. For more information, contact CPS at firstname.lastname@example.org.
1 US Food and Drug Administration. Biosimilar and interchangeable products. Current as of October 23, 2017.