Gary Lyman, MD, MPH, an oncologist and hematologist, discusses how biosimilar placement on formularies affects physicians' willingness to prescribe these agents.
Gary Lyman, MD, MPH, is an oncologist, hematologist, and public health researcher who has long been an advocate for biosimilars. He has also developed guidelines in support of using biosimilars in the oncology space.
What’s your take on payer formularies and how biosimilar placements on these preferred lists affect use at the physician level?
Lyman: Well, the payer formularies and prioritization, in some cases, have a fairly profound impact on what drugs oncologists and other clinicians can use because it directly impacts the patient. Oftentimes, by prioritizing a certain therapy or certain biologic, a payer is saying that we will cover that and either not cover alternatives if you decide to not to use the favored agent or not pay at all. The burden is left either on the patient in terms of a much higher cost of care or is borne by the institution and the provider, which, of course, is not an attractive option either.
So, in the end, although we talk about guidelines and how health care systems themselves have their own favorite agents, ultimately, they have to meld with the payer because of that reimbursement for these costly drugs. If [a drug] is not fully reimbursed, that directly impacts the patient and the provider. So, I would say it's a fairly dramatic effect.