Bottom Line: |
Manufacturers of biosimilars should explore and emphasize the opportunity to enhance the affordability and accessibility of biologic medications within the federal healthcare landscape. |
Biosimilars represent a significant opportunity to enhance the affordability and accessibility of biologic medications within the federal healthcare landscape. Agencies such as the Veterans Health Administration (VHA), the Defense Health Agency (DHA), and the Department of Indian Health Services (IHS) play an important role in providing high quality healthcare to their beneficiaries and can benefit from leveraging the cost-savings generally associated with these products.
The foundation for biosimilar utilization in the federal market rests upon several key factors, including the pathway created as the patents on originator biologic products expire. This commercial marketplace competition ultimately drives down drug costs, which can be very important to these health systems with pre-set budget limitations. With the federal government's inherent focus on cost containment, exploration of cost-effective treatment alternatives, like biosimilars, is often welcomed. This focus is further underscored by the understanding that every dollar saved through the utilization of less expensive medications can be redirected towards enhancing patient care and expanding access to other treatments. As such, federal payers often prioritize interchangeable biosimilars due to the product’s reduced cost.
To maximize the impact of biosimilars within the federal market, manufacturers should adopt a comprehensive yet strategic approach to this market. It is very important for a manufacturer to understand each agency’s purchase pathway options and limitations as well as the impact of formulary placement within each agency. Once a product’s formulary status as well as associated prior authorizations, criteria for use, and/or monographs are set, outreach to educate federal healthcare providers, pharmacists, and patients about the availability, safety, and efficacy of biosimilars can be mapped to ensure proper ROI for the appropriately scoped resource allocation.
Biosimilars offer a compelling opportunity to enhance the affordability and accessibility of critical biologic medications within the federal healthcare landscape and manufacturers should embrace the opportunity offered. Our team has published additional in-depth analysis that further explores these intricacies.