Biosimilars: What employers need to know

Earlier this month, Novartis’ Zarxio was the first biosimilar product approved in the United States, ushering in a new era for the drug industry, consumers and third parties who manage medical and drug benefits.

Given the confusion over the U.S. Food and Drug Administration’s approval process and specialty-related product availability, Cheryl Larson, vice president for the Midwest Business Group on Health, and Randy Vogenberg, principal for The Institute for Integrated Healthcare, wrote an article on questions employers should be asking related to biosimilars.

So what’s an employer to do?
1. Have a conversation with your pharmacy benefit management organization and/or health plan regarding their coverage approach or policy related to biosimilars. If you have questions about how biosimilars are different, ask them.

2. Review your vendor contract and coverage of specialty drugs to determine the impact on current or future plan costs to your organization.

3. Review your own plans’ drug use patterns and if this type of approval would make a cost savings difference to your members.

4. Determine if this will make any difference on annual cost trend for the plan versus just the unit cost of a particular drug for an individual medical condition like cancer-related anemia.

5. Continue to advocate for full cost transparency on all specialty drug products by your vendors.

The full article published in Employee Benefit News can be found here. 

Additionally, MBGH offers free tools and resources to help plan sponsors stay current on issues related to specialty pharmacy drugs, benefit design and contracting strategies at www.specialtyrxtoolkit.com.