National Alliance Playbook Guides Employers on Biosimilar Adoption

The National Alliance of Healthcare Purchaser Coalitions (National Alliance) has announced the publication of its playbook which aims to encourage biosimilar adoption among employers.

“If properly managed, biosimilars can help employers save millions while increasing patient access,” Margaret Rehayem, vice president at National Alliance, said in the press release. “As the use of these drugs continues to expand in the US, we’ve been working with coalitions and employers to develop strategies to help drive acceptance and appropriately push back on health plans and pharmacy benefit managers that are not transparent or have misaligned incentives.”

Employers face multiple barriers to incorporating biosimilars into their pharmacy benefits. For example, employers may be under the impression that biosimilars will boost their healthcare spending overall due to the lack of rebates. Pharmacy benefits managers may reinforce this idea and may engage in practices that are currently under legal scrutiny.

However, National Alliance disputed this idea, to the surprise of some participants in the organization’s learning collaborative.

“We are late in prioritizing biosimilar management,” Cathy Trinh, senior healthcare analyst at SEIU 775 Benefits Group and a participant in the biosimilars learning collaboratives, said in the press release. “It’s shocking to learn how much we could have saved in the last few years if biosimilars were used instead of the reference products.”

The playbook offered advice around plan and formulary design, drug pricing and rebates, general pharmacy benefits, and the steps toward biosimilar adoption. The document also included a section on Humira, a popular prescription drug for rheumatoid arthritis that lost its patent in early 2023 opening the door to Humira biosimilars.

Employers should consider the policy of placing all newly-released biosimilars in the generic tier of their formularies. They may also apply the same incentives across all biosimilars in a drug class. These steps could improve employee uptake, the playbook explained.

National Alliance suggested moving away from rebates-driven formularies, leaning instead on phases or a specifically-tailored design. In addition to avoiding these formularies, employers should forego 340B pricing plans except for low-wage workers.

Employers can also form carve-outs with specialty pharmacy benefit managers (PBMs) or specialty pharmacies that can cut costs. Experts have predicted that payers will focus on specialty pharmacies as a way to reduce healthcare spending in 2023.

For employers who are unsure how to pivot toward biosimilar adoption, National Alliance provided seven action steps. First, they should know the context, which involves collaborating with health plans and PBMs to create a strategy. Then, they should ask their health plans which workers will most benefit from biosimilar uptake.

Employers should assess which biosimilars are already included in their formularies. They might want to design a biosimilar preferred formulary as well.

Employers should analyze their pharmacies’ billing practices and their health plans’ utilization management details. They should also investigate which patient support programs are best-suited for their patient populations.

“Don’t dismiss available clinical support programs or patient copay assistance as ‘inducement.’ Specialty drugs are not discretionary medical treatment,” the playbook explained.

Lastly, they should outline a plan for communicating with vendors, PBMs, providers, and patients.

“Companies are spending more on employees’ health insurance than ever before, and biosimilars are safe and effective treatment options to lower the cost of prescription drugs if they are accessible to the patients that need them,” said Juliana M. Reed, executive director of the Biosimilars Forum. “We urge employers to implement recommendations from this playbook and work with their PBMs to ensure their employees have access to lower cost biosimilars and are educated about them.”

The materials also called out pharmaceutical entities that may be trying to stave off biosimilar emergence to retain control of the market.