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
Transcript:
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.
PBM Evolution Toward Value-Based Care Shifts to Transparent Pharmacy Pricing
March 30th 2025Josh Canavan, PharmD, RazorMetrics, and Chris O'Dell, Turquoise Health, predict pharmacy benefit managers (PBMs) will evolve toward value-based care, mirroring the broader shift toward open-cost structures.
How AI Can Help Address Cost-Related Nonadherence to Biologic, Biosimilar Treatment
March 9th 2025Despite saving billions, biosimilars still account for only a small share of the biologics market—what's standing in the way of broader adoption and how can artificial intelligence (AI) help change that?
Empowering Vulnerable Populations: The Path to Equitable Biologic Therapy Access
December 22nd 2024Elie Bahou, PharmD, senior vice president and system chief pharmacy officer at Providence, discusses strategies to improve equitable access to biologic therapies, including tiered formularies, income-based cost sharing, patient assistance programs, and fostering payer partnerships.
Biosimilars in America: Overcoming Barriers and Maximizing Impact
July 21st 2024Join us as we explore the complexities of the US biosimilars market, discussing legislative influences, payer and provider adoption factors, and strategies to overcome industry challenges with expert insights from Kyle Noonan, PharmD, MS, value & access strategy manager at Cencora.
Can Global Policies to Boost Biosimilar Adoption Work in the US?
November 17th 2024On this special episode of Not So Different honoring Global Biosimilars Week, Craig Burton, executive director of the Biosimilars Council, explores how global policies—from incentives to health equity strategies—could boost biosimilar adoption in the US.
Q&A With Dr Chelsee Jensen: Navigating FDA Approvals, Challenges in the Biosimilar Landscape
January 14th 2024Chelsee Jensen, PharmD, BCPS, senior pharmacy specialist and pharmaceutical formulary manager at Mayo Clinic, reacts to the biggest FDA approvals of 2023 and how she sees the adalimumab, natalizumab, and tocilizumab spaces playing out.