Empowering Vulnerable Populations: The Path to Equitable Biologic Therapy Access

In an interview with Elie Bahou, PharmD, senior vice president and system chief pharmacy officer at Providence, he discussed strategies to overcome barriers to biosimilar adoption within integrated delivery networks (IDNs) and ensure equitable access to biologic therapies. Bahou emphasized the importance of tiered formularies, prior authorization optimization, and income-based cost-sharing models to reduce financial burdens on patients.

He highlighted the need for robust patient assistance programs and private safety nets, particularly for rural and vulnerable populations. He also underscored the role of partnerships between trusted biosimilar manufacturers and payers to streamline access and reduce health care costs.

This transcript has been lightly edited for clarity.

Transcript

What role do social determinants of health play in shaping coverage decisions for biologic medications, and how can policy adjustments help reduce disparities in access?

Yeah, I think the best way to do that is just have an income-based type of cost-sharing, co-pay structure would be very beneficial, like when a senior goes on Medicare when they're 65—we're all eligible for that. But let's say you're 65, you're pretty well off, you've got a lot of dividends coming in, rental income, you show more on your tax return, your Medicare co-pay is going to be more than somebody, let's say, that only shows $30,000 a year. They're going to pay less on their co-pays for the medication that way, and then having a solid patient medication assistance program, co-pay assistance program with these drug manufacturers, and then a safety-net private program pick up that cost differential that may not be picked up, and then to continue to serve really the rural areas that we have. That's really our mission: to serve the poor and vulnerable over here at Providence. That's our goal.

How can health care providers and payers benefit from the supply chain efficiencies that come with contracting with fully integrated biosimilar manufacturers?

Yeah, so there, you can imagine a lot of patients when I practice pharmacy. They used to come in and say, "Hey, Elie, can I get the 30 days supply?" "Sure, it's $400." "Oh, my God, I can't afford it. Give me 5 days [instead]." It's kind of like going to gas station getting $5 to fill up your tank. Believe it or not, that's what they used to do. Some of them even go to Mexico to buy it because I practice at Dana Point in [Southern California]. So, patients that are not able to afford their medication due to the cost or to co-pay should, I feel, have access to options to be able to get their medications. We need to also provide education on the importance of the therapy and adherence, especially in populations that don't understand that, and ensure patient access to get into the care needed, and then support the overall policies that include broad health care coverage, regulatory support for cheaper biosimilars and facilitating its uptake. It's sad when I see the prices of some of these drugs, believe me. Yeah, I'm going to be a senior. I'm 62 years old. In 3 years, I'll be on Medicare. Like, what? [It'll cost] how much? It's crazy.

How can vertically integrated biosimilar companies play a role in reducing health care disparities?

Yeah, that's really, really important. I think the best way to do that is just have a well trusted manufacturer with solid quality and redundancies built into their process, with a broad portfolio and pipeline of biosimilars, is probably the best case scenario for a model vendor to partner with and have access to all therapies provided. And in order for us to achieve that, there needs to be a similar understanding from the payers, the folks that pay the bill, to allow these partnerships to flourish by having these therapies on the payer formulary. A doctor can prescribe XYZ drug but if the payer, the insurance company—like UnitedHealth Group, CVS, Caremark, Aetna—if they don't cover it, gotta go back to the drawing table. Nobody can afford to pay a couple of thousand dollars out of pocket for every month for a drug. So that's the best way to do it.