Challenges in Biosimilar Acceptance, per Savitha Vivian of OptumRx

This brief Q&A has been edited for length and clarity.

Q: Of the upcoming biosimilars to note, when are we expecting them to go to market?

A: Of the biosimilars to note in terms of upcoming launches in 2022, we're anticipating the launch the biosimilar to Actemra. In 2023, we're anticipating the biosimilars for Humira and Stelara to come to market.

Q: What are the primary challenges you're seeing with biosimilar acceptance in coverage and which medications in particular?

A: So patient and provider comfort with biosimilars is still a critical barrier to the adoption of biosimilars. There's been an increase in prescriber and patient education which has led to the confidence through experience we've had so far with the biosimilars, especially in patients who are new to therapy. We've seen a lot of providers get comfortable with starting a patient who's never been on therapy with a biosimilar - many current FDA approved biosimilars today that we have treat very specific hard to treat conditions, chronic conditions. Switching therapies in these patients, once they're stable on a therapy is not usually recommended unless they're their therapy stops working or the patient experiences unwanted side effects. So switching therapies in these patients who are stable can be a difficult decision for a provider as well as the patient.

From a clinical perspective, we need to be cautious in implementing strategies that force these types of switch. Now, what we really need is data showing that there's really no additional risk from switching therapies in these hard to treat or hard to control chronic diseases. That's going to really increase or boost the confidence for prescribers to start using biosimilars in those states in those stable patients.

The second barrier, and I think, to address this barrier, one of the solutions is interchangeability. There's been a lack of interchangeability to date. However, that is starting to change. This year, we saw the launch of the first interchangeable biosimilar which is Semglee, the biosimilar for Lantus insulin. This can really facilitate biosimilar adoption for two reasons. One, these in order to demonstrate interchangeability, there has to be studies that show there is no additional risk or there's reduced efficacy if a patient switches back and forth between the interchangeable biosimilar and the reference product. So it kind of answers or addresses that physician concern about switching in hard to control disease states. Second, biosimilar products depending on state laws, can be substituted for the brand at the point of dispensing. So pharmacists could dispense a biosimilar if the prescription is written for a brand, just like they do today with traditional brand and generic drugs. That'll facilitate the use of biosimilars as well.

Those are the two two big reasons why I think interchangeability will help overcome some of the the last barriers left in biosimilar adoption.

I think pharmacy care organizations like Optum, are going to leverage the competition among prescription drugs and in order to help reduce costs for patients and whether that competition comes through the approval of more brands, whether it comes through the approval of traditional generics, or biosimilars. This is all good competition that really enables our organization as well as payers to effectively lower prescription drugs for not only our our patients, but with the clients that we serve as well.