As Biosimilars Change the Payer Landscape, Pharmacists Can Help Patients Access, Manage Complexities

In an interview with Pharmacy Times, Cate Lockhart, PharmD, PhD, executive director of the Biologics and Biosimilars Collective Intelligence Consortium, discussed the growing biosimilars landscape and what it means for payers and patients. Lockhart will be presenting on this topic at the 2023 Asembia Summit, in a session titled “Will Biosimilars Be Larger Than Life? A Review of Payer Response to Changes in the US Landscape.”

Q: What has the response from payers looked like thus far in the US, and how is this evolving or changing?

Cate Lockhart, PharmD, PhD: The response from payers around biosimilars has been consistent, I think, across payer types, but also it has been improving over time. The payers were always pretty comfortable with the science around biosimilars and understanding that there is no clinically meaningful difference. I think as more clinical experience is generated over time, I think people are becoming more and more comfortable with the whole idea of biosimilars, including switching between biosimilars or from an originator product to a biosimilar product. So, I think the comfort level continues to increase with payers over time. I think that's positive. And I think that hopefully helps remove at least some barriers to potential adoption, if there's concerns about reimbursement or if payers are putting in policies that are restrictive at all, and we're not really seeing that to be the case so far.

Q: How do you predict biosimilars will change the payer landscape in the next 3 to 5 years?

Cate Lockhart, PharmD, PhD: The really interesting thing about payers and biosimilars right now is that they—the payers—are playing a much, much larger role now than they were before. Prior to 2023, all of the products were covered under a medical benefit, they were provider or clinician administered in an outpatient or an inpatient setting. And now we have the adalimumab products that are dispensed by a pharmacy. And so that changes the dynamic but also, when you have multiple products for a single molecule, how do you manage that from a cost perspective? Looking at your pharmacies, your specialty pharmacies, do they have to stock 9 adalimumab products? And so, I think the payers are having a much more prominent role in the conversation now than they were even last year. And I think that's only going to continue over the next 3 to 5 years as we continue to get more and more products for a given reference product and more and more classes of drugs that are available, that are much more in the front and center in terms of formulary management and pharmacy and therapeutics committees and things like that.

Q: How can pharmacists help patients access biosimilars and manage the complexities of payers?

Cate Lockhart, PharmD, PhD: Pharmacists are also becoming a much more important piece of the biosimilar conversation, again, than before. Before now, the products were medical benefit and dispensed in a hospital, pharmacy, or clinic. And so, a retail pharmacist or a pharmacist who's in direct communication, direct patient care, hasn't really been as much a part of the picture. But that's changing very fast. I think there's a real, very much needed opportunity here to include pharmacists in the education landscape. They’re on the front line, they're the ones that are talking directly to the patients, and when they get a box that looks different, the pharmacist really needs to be able to talk to the patient about that. And I think having pharmacists really on board with understanding biosimilars, and being able to communicate that to their patients, I think that's going to be invaluable as biosimilars move forward. And of course, the payer conversation comes into that, as these then are, you know, adjudicated for reimbursement at the pharmacy counter. And so having pharmacists also able to understand the payer landscape around biosimilars, I think is going to be also quite essential for biosimilars, as they become more directly available at a pharmacy counter, whether it's a specialty pharmacy or a retail pharmacy. All those are coming.