Chelsee Jensen, PharmD, pharmaceutical formulary manager at the Mayo Clinic, explains what health organizations and health systems can do to better manage and instill confidence in biosimilars.
Chelsee Jensen, PharmD, pharmaceutical formulary manager at the Mayo Clinic, shares actions that can help improve patient confidence in biosimilars and weighs in on whether interchangeable ranibizumab biosimilars will impact how people view interchangeability designations.
What can health organizations do to ensure that biosimilars are well-managed and that patients are confident in their utilization?
Jensen: I believe that to ensure that your organization remains engaged is to have timely report outs of how are we utilizing biosimilars? How are we saving money? How are our patients doing? Have there been any safety or efficacy signals reported back? Again, in our experience, there really have not. But continuing to keep those people engaged—How was the prior authorization process working? Are our payer landscaping changes? Are their contracting changes?—keeping all those players engaged is going to really help promote...the continued use of biosimilars, and again, reduction of health care expenditures overall.
How can health systems be active members in the fight for better biosimilar legislation and policies?
Jensen: I would say really continuing to advocate and lobby, especially for real-time benefit checks on medical benefit. I think that would significantly reduce burden at many, many levels. So, continuing to push for that is really important, as well as CMS to keep in check of are they being transparent and what are Medicare Part D plans doing vs Medicare Part B plans doing? I know there was an Office of Inspector General report released in March of 2022 that showed a lot of Part D plans actually were not incentivizing or even covering biosimilars compared to the reference product.
So, I think as we especially change to this more PBM [pharmacy benefit manager] space, in 2023 and beyond, it's really important to keep in focus of how those Part D and B plans covering biosimilars. Are they incentivizing them? And if we are not seeing health care savings, again, to take a better look on how those are placed on formulary tiers.
Recently, Cimerli, a ranibizumab biosimilar, launched on the US market with an interchangeability designation. However, because it is not a product dispensed in pharmacies, the designation will not apply. How might the market introduction of this product with this designation impact how stakeholders view interchangeability and the safety of biosimilars overall?
Jensen: I truly don't think there's going to be much of an impact on how people view safety of biosimilars or interchangeability. I think it's truly going to come down to what are the covered indications and how are they contracting? So, maybe a health system might have to carry both the Byooviz [another ranibizumab biosimilar] and Cimerli because they didn't get favorable contracting and driving towards one, where you have patients who are covered by 1 indication and then the other product for the other indication.
So, I think it's going to create a little bit of a management issue, but again, it's going to come down to competitive contracting. However, I do believe that providers will naturally move away from reference Lucentis.