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Biosimilars, Private Payers, and Pharmacy-Level Substitution


Amanda Forys, MSPH: Do you think that these plans will go far enough to reduce costs? Do you think that these types of ideas of keeping the codes separate—potentially letting this whole manufacturer rebate coverage gap discount program that might play out in Medicare—do you think this will also push private payers to start developing innovative strategies to encourage uptake and use of biosimilars and help us have system-wide cost-savings?

Christy M. Gamble, JD, DrPH, MPH: Yeah, you know, I think it’s a nice step. It’s a good step forward. I really say that we should be hesitant and we should make sure that we don’t push policies that would be harmful to the market or harmful to the patient, is what the end game will actually be.

We need to start thinking innovatively about how to make sure patients can get access to—I’ll continue to say that—get access to lower-cost drugs. If it takes looking into these types of policies and adding on in the future, [and] seeing if there was any harm that comes from the policies and doing some tweaks and changes, we’re all for that.

Another conversation that we would like to continue is the substitution by pharmacist of biosimilars for biologics [and] making sure patients can get that lower-cost biosimilar, even if they get a prescription for a biologic when they go to the pharmacy.

Amanda Forys, MSPH: Let’s talk a little bit about that, that’s interesting because then you have the whole interchangeability issue. From my understanding, some states have just made their general decision that they would just make for any drug; if the [pharmacist] does change it, they have to notify the doctor within a certain amount of days. We see that in a lot of states. Is it interchangeability, do you want to see biosimilars get interchangeability so the prescriber can just switch it, or do you want to see even just a biosimilar, now that it’s approved for the same indications, be treated as interchangeable?

Christy M. Gamble, JD, DrPH, MPH: Yup, absolutely. We want to make sure—because patients are not, like I said, for certain disease states, patients are not aware of biosimilars so they don’t know to advocate for it. Providers may not be aware of it, but if it’s safe and effective for treating that disease state, we want patients to be able to get access to it with the least amount of barriers possible.

Instead of having to go back to a provider, which travel is an issue, and thinking about the concerns of a patient having to actually go back to a provider to get this prescription, we want to remove some of those barriers and make sure patients get access to [it], making sure it’s still safe and effective. Every patient is different, so we want to make sure that we have what treats their condition effectively, but at a lower cost.

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