How Strategic IDNs Boost Biosimilar Adoption

Sophia Humphreys, PharmD, MHA, BCBBS, director of system formulary management at Sutter Health, explains that biosimilar adoption relies on clear strategies in the "buy and bill" medical benefit space. Successful integrated delivery networks (IDNs) collaborate with group purchasing organizations (GPOs) and 340B programs, regularly assess cost factors, and integrate biosimilar tools into electronic health records (EHRs) to simplify prescribing for physicians. Prior authorization processes for both biosimilars and reference products also streamline care. Regular performance reviews and sharing results with leadership help drive continuous improvement in biosimilar uptake.

First, Humphreys notes that we need to differentiate between medical benefit and pharmacy benefit. Many of the most successful biosimilars are in the medical benefit space, especially in the "buy and bill" space. IDNs that work closely with GPOs, 340B branches, and formulary management teams perform regular reviews of coverage, patient mix, and average sales price vs acquisition cost. These analyses help them decide which biosimilars to prioritize.

Additionally, some IDNs have built biosimilar tools into their EHR systems to streamline physician workflows. Physicians are extremely busy and can’t be expected to remember which product to use each quarter, so it’s important to build support into the system. Some IDNs have also incorporated prior authorization processes for both the reference product and biosimilars, further streamlining care. Finally, it’s crucial to conduct regular performance reviews and share success metrics with leadership. This continuous improvement process elevates the entire system.