Impediments to biosimilar access prevent market competition from working properly, raise patient cost-sharing and harm long-term sustainability of biosimilar development.
Insurers and PBMs are increasingly implementing white-bagging policies, which require oncology practices to obtain physician-administered infusions and other medications from designated specialty pharmacies often owned by or affiliated with insurers and their PBMs.
Reforming the current PBM market is a pro growth reform because government policies have misaligned market incentives which imposes excessive costs on patients.
Not being privy to reasons why certain formulary decisions are made is a problem. More transparency in the health insurer decision making process would help consumers.
Prerakkumar Parikh, PharmD, of Megallen Rx Management/Prime Therapeutics, detailed the impact of formulary placement of biosimilars on cost burden along with how stakeholders can work with pharmacy benefit managers to promote biosimilar use.