Expert Insights on Overcoming Patient Education Gaps, Biosimilar Financial Hurdles

Josh Canavan, PharmD, head of pharmacy at RazorMetrics, and Chris O'Dell, senior vice president of market solutions at Turquoise Health, discuss how the health care system must overcome patient education gaps and address perverse financial incentives within contract structures that currently favor higher priced reference products in an interview with The Center for Biosimilars^®.

Canavan highlights patient and provider education as the primary challenge and opportunity. He emphasizes pharmacists' crucial role in educating patients about biosimilars, navigating prior authorizations, and providing essential feedback to address barriers.

O'Dell focuses on perverse financial incentives within the current market structure as a significant impediment. He explains that contract structures, particularly those where entities profit from higher drug prices, discourage biosimilar adoption.

This transcript was lightly edited for clarity; narration and captions were generated by AI.

Transcript

Narration: The adoption of biosimilars within the health care system faces significant challenges. These include overcoming gaps in patient and provider understanding, as well as addressing existing financial structures that may inadvertently favor more expensive reference products.

From your perspective, what are the most significant factors influencing the adoption of biosimilars in the current health care landscape, and where do you see the greatest opportunities or challenges for improving their uptake?

Canavan: It's education. The recurring theme here is education, and pharmacists are a huge touch point with patients at the pharmacy counter. One of the things that being a pharmacist helps with is acknowledging that the patient may have some issues with this. It may be a different medication than they're used to taking. They may not even know what a biosimilar is, and trying to talk about that before explaining what it is, or having any baseline education around that, is a problem. The pharmacist really alleviating some of those issues that the patient may have is going to be huge with biosimilars.

Another thing we see is prior authorizations. Even with biosimilars, sometimes those require prior authorizations from the PBM. It is explaining to the patient why that's taking place, why it's happening, even with the biosimilar, making sure that they know they will be able to get their medication, even if there is a slight delay in it.

Also, pharmacists are great with the feedback loop. When we talk to pharmacists at Razor, we ask a lot of questions about what they're seeing at the pharmacy, how things are working, and problems they're facing. They relay those to us, and then we can help break down those barriers again, helping the patient get the medication. There's a lot of empathy there with pharmacists. They want the patient to have the medication as soon as possible. We want the same thing. How can we work together with that feedback loop to make sure that happens?

O’Dell: Let's take 2 different contract structures, one that is paying you some markup on the drug and one that is paying you at a set fee schedule. In one system's case, or in one PBM's case, the system actually makes more when you increase the price of the product. In the other one, the end system, let's call this the payer in this example, actually has to pay less when they decrease the price of the product.

When you look at a reference price, you have to say by dropping ASP [average sales price] way, way, way, way down, so you've rebated the system heavily, tried to promote "Hey, I will give you the kitchen sink if you just use my biosimilar relative to the other product". If they don't make more money on that, meaning you drive the ASP down, and they're getting paid at some variation of ASP, then it's all for naught. The market's not working well because as the price goes down, the end entity who's prescribing it is making less and less margin than they were on the reference product.

That has probably hindered adoption of biosimilars relative to what we would expect because if it were cheaper and just as clinically efficacious, meaning that the patient got it for cheaper, the payer paid less, and the manufacturer could still make a margin on it, then we would see much broader adoption. I think there are a lot of perverse incentives, things like rebates, maybe when you get paid relative to the sticker price, which is WAC [wholesale acquisition cost], then your margins are much better, that have allowed the reference product to stay bolstered and commonly used relative to the biosimilar.