Businesses Have a Financial Stake in Promoting Biosimilars, Employer Groups Say

At a panel discussion at the 14th Biosimilars Summit, held January 22-23, 2019, in Alexandria, Virginia, representatives of employer groups and others discussed the role that businesses have in driving the discussion about raising awareness and adoption of biosimilars. Employer groups can help overcome barriers, such as patient fears and misinformation, and create confidence about using biosimilars, speakers said.

“I believe biosimilars fit in very much with what employers are looking for,” said Brian Lehman, MBA, MHA, RPh, director of medical account management and strategic alliances at Sandoz, Inc, and board member of The Center for Biosimilars^®

. Besides increasing access and providing savings, they help with issues like absenteeism and presenteeism, thus increasing productivity, he said.

Generics have only provided “incremental” savings year over year, he said.

Employers and employer groups can help address some of the fears that people have about biosimilars, given that 60% of Americans are covered by health insurance through work, speakers said.

Matthew Harman, PharmD, MPH, director of pharmacy, Employers Health Coalition, Inc, which represents more than 400 organizations in 32 states, said it is not uncommon now for chief financial officers to sit in meetings looking at spreadsheets of healthcare costs. That’s giving rise to such questions as, “do I have to cover specialty drugs at all?” he said. Or, he added, they are trying to create custom formularies.

For many employers, it comes down to their tolerance of disruption versus risk, he said.

In addition, another hinderance to biosimilar adoption by employers is that many have come to appreciate rebate checks from pharmacy benefit managers (PBMs), and they will need education to look at the short-term versus long-term costs of that decision. Tools that business groups and employers can consider using are turnkey solutions and how-to guides, as well as different co-pay tiers for specialty pharmacy drugs, Harman said.

For example, he cited the National Business Group on Health’s guide to cancer care. A similar guide could be developed for employers regarding biosimilars, he said.

Lauren Vela, who is senior director of member value at the nonprofit Pacific Business Group on Health (PBGH), noted that since employee benefit and human resources (HR) departments do not generate revenue, they are cost centers and, as such, are short-staffed and overworked. HR people by nature are not risk takers, and they are also not healthcare experts, especially when it comes to dealing with PBMs.

Vela said it isn’t easy to create a custom formulary, given the nature of the HR workplace, but it can be done. HR executives who are told by PBMs that changing 1 part of their contract for specialty drugs would change other parts as well should verify that information with an actual analysis.

“They make it very difficult for payers to create custom formularies,” Vela said of PBMs.

Vela said providers should also be paid differently and make them responsible for the total cost of care as well as patient outcomes, as in accountable care organizations. That makes the adoption of biosimilars perfect for employers, she said.

But from their perspective, providers have no incentive to change what they do and how they do it if a payment change only affects a small sliver of their patient base, she noted.