Though the Academy of Managed Care Pharmacy (AMCP)’s 2024 Annual Meeting may be over, the wealth of topics and insights shared by our managed care pharmacy teams in New Orleans are as relevant as ever. 

We caught up with Prerak Parikh, PharmD, director of medical pharmacy strategy, to learn more about his April 17 session, “Breaking Boundaries with Interchangeable Biosimilars: The Sequel.” 

Alex Cook: Can you tell us a bit about your session?
Prerak Parikh: “Breaking Boundaries with Interchangeable Biosimilars: The Sequel” covered all aspects of interchangeable biosimilars, from state and federal regulations to clinical and operational management. We covered the key differences in management of interchangeable biosimilars between pharmacy and medical benefit. We also discussed best practices from medical benefit perspective and the impact of interchangeable biosimilars on cost and coverage. Lastly, we touched upon the pipeline in this space and future impacts.  

Biosimilars are a very complex topic, but as we look at changing individuals between certain therapies, what managed care considerations are being made?
As more interchangeable biosimilars flow into the market, it becomes crucial for the health plans to be prepared to effectively manage them. From a medical benefit operations standpoint, plans can configure their claims system to allow coverage for lower cost interchangeable biosimilar and enable an easier prior authorization process for providers. Health plans should track launch dates of these biosimilars, the cost at which they launch, and how that impacts pricing of other drugs in the same therapeutic category. This is an important piece for developing a preferencing strategy. Lastly, provider education is extremely important — biosimilars are better adopted if the provider networks are on board with a health plan’s preferencing and reimbursement strategies.  

 I understand you explored how regulators are involved in this issue. What are some of the key challenges we are seeing?
Interchangeability designation is defined at a federal level, however the automatic substitution rules may differ from state to state. At this time, the biosimilar interchangeability concept is not as easy as brand-to-generic substitution.  

There are more interchangeable biosimilars in the pipeline. How are they going to change the market landscape?
Interchangeability status allows for easier substitution of biosimilars at a pharmacy level and thus provide better access. With more biosimilars coming to market, it will only generate more competition ultimately lead to cost reductions for patients and payers. 

Interested in learning more about specialty drugs? Tune in to our Pharmacy Friends episode with Kristen Reimers, SVP of specialty clinical solutions at Prime Therapeutics/Magellan Rx Management.