Employers have long been a silent stakeholder in the healthcare system.
Employers have long been a silent stakeholder in the healthcare system. In 2017, it was estimated that approximately 49% of the US population was covered under employer-based health insurance; while this number has generally been consistent over the years, the changing dynamics of the healthcare system have made it more important than ever to consider this often silent stakeholder.
Rising healthcare costs and the introduction of biosimilars have boosted the conversation around employers, but the role and influence of employers in biosimilar uptake is still unclear. Employers can be considered a go-between for payers/pharmacy benefit managers (PBMs) and patients, negotiating benefit designs with payers/PBMs and, in turn, providing accessible healthcare to employees.
In recent times, the cost of employer-sponsored healthcare benefits has increased, and is expected to approach $15,000 per employee in 2019. A large proportion of these costs are attributed to specialty drugs, and to combat rising costs, employers are pursuing cost-saving strategies. This pursuit has put employers in a position of power to drive down healthcare costs. In doing so, it is critical for employers to be at the forefront of biosimilar uptake.
Employer Biosimilar Education
Employers are key decision makers in providing healthcare access to employees. The foundations of their decisions on benefit design and gravitation towards plans like high-deductible health plans are based on cost savings. Manufacturers can leverage this fact to drive engagement with employer groups on biosimilars. Manufacturers must continually communicate the value of biosimilars to employer groups with regard to clinical applicability and cost savings in terms of both discounts and long-term savings opportunities.
Employee Biosimilar Education
Employers can also use their influence to drive employee education on biosimilars. This can easily be done through benefits communications and organizational initiatives. The lack of patient awareness of this drug class is one key reason for slow uptake, and more emphasis on the clinical (eg, transitioning from reference to biosimilar products) and financial value of biosimilars can increase patient comfort and familiarity.
Negotiations with Payers on Benefit Designs
Benefit design is perhaps the most important area in which employers can play a role in biosimilar uptake because they have insight into the healthcare costs of their organizations. For example, they may be able to assess how much spend is going towards specialty drugs or specific conditions. This information can assist employers in selecting the following year’s health plans and can also be a negotiating tool with payers/PBMs for formulary and product management.
Furthermore, employers determine whether employees will face co-payments or coinsurances and discuss formulary tiering and utilization management, including prior authorizations and step therapy, with payers/PBMs.
If the value of biosimilars is adequately communicated to employer groups, employers may be biosimilar advocates when negotiating their selected health plans. For example, employers may prefer to have biosimilar products, like Inflectra, on a lower specialty tier versus reference biologics, like Remicade, if justifiable cost savings exist. Incorporating biosimilars into employer-based coverage would in turn improve patient access to this class greatly.
Despite their power, employers remain an untapped stakeholder that can drive healthcare change. Appropriately communicating the long-term value of biosimilars to employers can lead to a trickle-down effect, with employers conveying this value to employees and bringing biosimilars into benefit designs. While these are only a few ways this group can be leveraged for biosimilar uptake, they are a stakeholder to consider, especially if incentivized with the cost savings that biosimilars can bring.