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Dr Mark Fendrick: Biosimilars in Value-Based Insurance Design


Mark Fendrick, MD, discusses the role that biosimilars will play in value-based insurance design (VBID).


Are biosimilars going to play a big role in value-based design?

The question about whether biosimilars play a role, branded drugs play a role, generics play a role, I think all of these questions about specific interventions take us back to what makes VBID different from other types of payment insurance schemes which is this era of clinical nuance.

It has always been our view that the value of a service depends not on the service itself, but who gets it, when in the course of the disease, by whom, and where. So, whether that be a branded drug, a generic drug, a specialty drug, or a biosimilar, there is a time in the course of the sequence of care where drugs are considered very high value, and that exact same drug might be considered low-value.

So as opposed to talking about preferred branded drugs or specialty drugs or biosimilars or generics, as many people know, there are some generics that I would pay people to take. There are also some generic drugs I would not give my dog. The same holds true for biosimilars. If there is evidence to suggest that a biosimilar at this point in time is a first-line drug, then the patient should have access to that and the provider should not have problems in terms of having to send faxes or make phone calls or whatever else to use it.

But that requires not just transparency, not just consumerism, not just skin in the game. This requires clinical expertise that fortunately or unfortunately most patients just don’t have. So instead of relying on patients to shop around, and make these types of decisions, I think the onus should be on providers. They for the most part want to do what’s best for their patients. We need to have their compensation systems aligned with good choices, but more importantly if a provider decides that something is best for his patient, whether that be a biosimilar, whether it be a specially drug, whether it be a branded drug or generic, when that clinical situation says that this is the right service for that person at this right time, there should be unfettered access to that.

So, I think in the avdent of any innovation, like biosimilars or maybe more importantly, these new CAR-T therapies moving forward, we need to access not only the clinical benefits that have come to them, not only the cost for which it has incurred, but understanding that drug and that cost, the value of which depends on the clinical scenario that it might be. It might be so important that you want barriers to fall and in some patients to do it, the exact same drug may be a complete waste and in another patient another scenario. And I think that’s where VBID fits in.

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