Formulary guidance and transparency from P&T to point of care

Biosimilar Reality Check? Payer, Pharma & Provider Perspectives

Posted by Matt Breese on Sep 15, 2015

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As the first biosimilar launches in the US, there are some key learnings for pharmaceutical manufacturers. Novartis’s launch of Zarxio sets a precedent for the slew of similar treatments to follow. When it comes to the marketing and launch of these products, Zarxio expresses that strategy should align with that of a branded product.  Using a fully integrated commercial organization supporting the brand, they are leveraging the same tactics that are proving successful in non-US markets.

With the majority of physicians restricting access to pharma reps, the similarity with branded drugs will mean that manufacturers will need to be creative with provider education on therapeutic effectiveness of their product and incentives. In Zarxio’s case, Novartis launches the drug at a 15% discount to compete even more aggressively with Amgen’s Neupogen.

For providers downstream, the introduction of biosimilars has a significant impact on the way patients are treated for specific therapeutic areas. Biosimilars are treated much more like therapeutic alternatives, presenting additional challenges for provider and pharmacy communication. Many argue that the landscape becomes even more complicated with the FDA’s direction on biosimilar naming which requires the use of unique, non-proprietary names for all biosimilar products. With these new products aimed towards providing an equivalent treatment at a lower cost for the patient, these types of barriers could be detrimental to provider adoption.

Many payers are calling for a reality check with the exceptionally optimistic view on how biosimilars relieve cost pressure on the nation’s healthcare system. Health plans are scrambling to determine exactly how these new treatments will be covered for patients. With biosimilars like Zarxio being prescribed and administered in clinical settings, P&T committees are actively engaged in discussions on how these therapies are maintained within the appropriate formularies.

It will be interesting to keep a close eye on the Zarxio case study to truly understand how biosimilars are received by each healthcare stakeholder.

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Topics: Specialty, Market Access