Overview and Common Misunderstandings of Biosimilars


An overview of biosimilars and common misunderstandings about the use of biosimilars among medical professionals and patients.


Kyle Skiermont, PharmD: Today we’re going to be talking about the biosimilar market in the United States. We’re going to start with a brief overview. Al, we’re definitely starting to see more entrants into the marketplace and a little more acceptance, but I think there is still a decent amount of misunderstanding from both providers and patients about what biosimilars really are. I think providers are getting excited about them. They’re starting to understand the potential cost savings with biosimilars but still aren’t 100% sure about how they’re coming to the market, when they can be used, and when they may actually be interchanged. I think patients, for the most part, have more questions and aren’t really sure what biosimilars mean for the marketplace.

Al Heaton, PharmD, BS, RPh: Yes, I agree with that. In the past few months, we’ve seen a slight uptick in biosimilar use, but it’s still about 7% in our payer mix. For the most part, patients haven’t raised a lot of questions to us, as a plan. Providers raise the questions. There has been a lot of misinformation out there. They’re just beginning to understand the whole concept of profitability and lower cost to our members.

Kyle Skiermont, PharmD: I would agree. In our health system, we’re talking to our providers. We are explaining the science and some of the approval process to them. I agree. I think those questions, where the misunderstandings were, are starting to turn into better education and a better understanding. We’re also seeing that a lot of the decision making is being driven by some of the plans, some of the plan decisions, and by extension because orders are being written. Our patients ask more questions because they’re asked to switch.

Al Heaton, PharmD, BS, RPh: Yes. We started with the biosimilar policy back in 2015 and had relatively small uptick in that. Now fast-forward. About 92% of our benefits that we have within a plan are high deductibles with HSAs [health savings accounts]. Suddenly that number is much more visible. They see this $5000 bill out of their physician’s office and are beginning to ask questions. “Are there alternatives?” “What are my costs?” And so biosimilars are just now beginning to hit members’ consciousness.

Kyle Skiermont, PharmD: I think that’s what we’re seeing as well. As I was saying, some of the plan design is really driving the patients to ask more questions. I’m sure they’re coming your way, from a plan perspective but definitely from a provider perspective as well. Patients are coming to you, whether you are a prescribing physician or a pharmacy team, and are really asking, “What is this biosimilar? Is it something that I should be concerned about? Is it safe? Can I change from this?” I think our staff has felt reasonably confident in being able to reply to them. Yes, this is the wave of the future. This is what’s coming. In fact, these are approved by the FDA. This is something that’s on the market for a reason and is able to be used based on a lot of science.

Al Heaton, PharmD, BS, RPh: Right. At first, the science was misunderstood. During the first 3 years of having our policy in place, we didn’t have a single member call about it.

Kyle Skiermont, PharmD: Right.

Al Heaton, PharmD, BS, RPh: It was all on the provider side. “I don’t want to use this” or “I don’t know about this. This is not a generic substitution; it’s something new and different.” We have tried to politely point out that we’ve had human insulin since 1982, which is very similar in the biosimilar concept but not necessarily from a regulatory perspective.

Kyle Skiermont, PharmD: That’s the example our teams have used quite a bit as well. The reality is, just as you described, the exact regulatory pathway is different, but the concept and some of the science behind it have been similar.

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