Surya Singh, MD, discussed dynamics that affect biosimilar uptake on the medical benefits side and how that differs from the pharmacy benefits side at the recent FDA/Federal Trade Commission workshop on anticompetitive practices.
Surya Singh, MD, is the president of Singh Healthcare Advisors
What are some of the dynamics that affect biosimilar uptake on the medical benefits side versus the pharmacy benefits side?
On the pharmacy benefit side, just to start there, the formulary concept and preferred drug concepts are critical to user uptake. So, getting that contract to become the preferred product, which in today's market is really around achieving the lowest net cost, is really critical. And that's done on a really large scale through a few entities, [which] do a lot of the procurement on the pharmacy benefit side; whereas, on the medical benefits side, individual health systems, academic medical centers, for instance, and then large multidisciplinary practices or specialty specific practices do their own procurement. So, the splintering of the market is much greater, and providers have to think about what would be the best, really, largely from an economic perspective, so [what would be the] lowest cost for them to inventory and then use across all of their patients and be able to [bill] for and receive reimbursement for across all of their patients. If it's a pure play, and it's going through either benefit, then the adoption issues become more clear, given that kind of framework. What becomes even more complicated is when there's both pharmacy benefit coverage and adjudication and medical benefit coverage and adjudication. So, you have both to contend with.