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How Does Your Health Plan Treat the New Biosimilars?

2015 MBGH Specialty Pharmacy Management Workshop Topic (held April 1)

From the National Business Coalition on Health:

"Earlier this month, Novartis’ Zarxio was the first biosimilar product approved in the United States, ushering in a new era for the drug industry, consumers and third parties who manage medical and drug benefits. The introduction of cheaper alternatives to relatively complex biologic drugs has created confusion over the U.S. Food and Drug Administration’s approval process and specialty-related product availability to be used or marketed."

"For plan sponsors, this situation is not ideal and continues to cause confusion around timing as well as terms important to benefit coverage sought by members as patients for these new biologic/specialty products from manufacturers. In addition, pricing has not been determined but is unlikely to rein in rising specialty drug cost trends or improve current year spending on medical or pharmacy benefits in the U.S."

Cheryl Larson, vice president of our sister coalition, the Midwest Business Group on Health, and Randy Vogenberg, principal for The Institute for Integrated Healthcare, highlight questions employers should be asking related to biosimilars in their April 14, 2015 article in Employee Benefit News.  

1. Have a conversation with your pharmacy benefit management organization and/or health plan regarding their coverage approach or policy related to biosimilars. If you have questions about how biosimilars are different, ask them. 

2. Review your vendor contract and coverage of specialty drugs to determine the impact on current or future plan costs to your organization. 

3. Review your own plans’ drug use patterns and if this type of approval would make a cost savings difference to your members. 

4. Determine if this will make any difference on annual cost trend for the plan versus just the unit cost of a particular drug for an individual medical condition like cancer-related anemia. 5. Continue to advocate for full cost transparency on all specialty drug products by your vendors. 

 The full article published in Employee Benefit News can be found here

Posted by Cristie Travis at 7:46 AM

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