Two AmerisourceBergen/Xcenda policy experts discuss the coming wave of pharmacy benefit biosimilars, formulary decisions, pricing transparency, and the Biden Administration’s push for lower-cost biologics.
In this interview, Center for Biosimilars® Senior Editor Tony Hagen discusses formulary decisions and drug price reform with AmerisourceBergen/Xcenda drug reimbursement experts Jennifer Snow, MPH, vice president of Reimbursement and Policy Insights, and Tasmina Hydery, PharmD, MBA, BCGP, assistant director of Integrated Technology Solutions.
Both Snow and Hydery discussed pharmacy and biosimilars in a panel discussion at the recent Academy of Managed Care Pharmacy Nexus 2021 meeting.
The arrival of pharmacy benefit biosimilars, particularly in the form of self-administered adalimumab biosimilars, could lead to much more negotiating activity between payers and physicians, who would become primarily prescribers of these products, rather than administrators, Snow says.
However, the crystal ball is hazy on the future degree to which prior authorizations factor into biosimilar use, she says. Snow is anticipating less of a role for prior authorization.
An interesting situation could develop when adalimumab biosimilars start to arrive on market. Much of the marketplace has already moved to citrate-free adalimumab, which is considered less painful upon injection: however, most of the approved adalimumab biosimilars contain citrate buffers, for drug stabilization, and there may be some pushback from patients who are asked to switch back to these agents simply because they may cost less than the originator agent, Hydery says.
Is the US market sufficiently patient centric? Snow says it’s much more payer centric, and that’s a function of the way the marketplace is structured. And although President Biden is continuing the effort to impose price reductions through controls, price negotiations, and imports, some of these ideas may never germinate, she says.
One proposal is to give all biosimilars and reference products from the same class of therapeutics an identical billing code, which federal policy experts say would help to spur competition and bring high-priced biologics into a more affordable range. However, Snow is concerned that code consolidation could pull the floor out from underneath drug prices and cause a “spiral” that could discourage competition, not encourage it.
The Biden Administration is also angling for greater price transparency, as much of what goes into determining the final cost of drugs to patients and health care institutions is hidden from public view. Hydery says this is a structural issue that by the very nature of the way business is done may not be easy to eliminate. “Even to this day, we don’t know who’s getting the cost benefit from a formulary decision, or the price benefit. Is it really trickling down to the patient?”