Meet the Board: David Calabrese of OptumRx Talks Wellbeing, Aduhelm and Biosimilars in the Market

Below is a brief Q&A of the interview with Calabrese that has been edited for clarity.

Q: Were you surprised by the approval of Aduhelm?

A: Was I surprised? I'll say no. It's not the first time we've seen the FDA make decisions that have varied from what an advisory committee may have recommended. Do I agree with the decision? I'd have to say that as a clinician who's prided himself on decisions based on evidence-based hierarchy, I think I'm a little disappointed by the decision, but I am appreciative of the challenges that the FDA had in front of it. Alzheimer's is a horrendous disease - growing prevalence as our population ages, we've had next to nothing in terms of new valued options for this patient population. The evidence is very limited. The evidence is is questionable.

I think the organization is under a good deal of pressure from advocacy groups and so forth in terms of their evaluation here. I think it's now up to the payers to make the decision as to how they feel. This product should or shouldn't be covered for their patient populations based on the evidence at hand. We'll see the additional studies that are going to be done and real-world evidence that will be accumulated over time with those that are going on the product to determine the true impact of the drug on disease progression. There's a lot of unanswered questions right now. I think time will tell, but again, I wasn't surprised because we've seen similar types of decisions. This was another great example, where the data was very limited, very questionable, FDA still proceeded with the approval. Was that the right decision? I think it led to follow on drugs that are demonstrating more and more value. So, there were positives that came from that and I'm hopeful that we'll see something similar here.

Q: This month, President Biden issued a directive that touched on a wide range of healthcare issues. The Biden directive seeks to put more generics and biosimilars on the market. Do you have any thoughts on that?

A: I think that's a positive thing. I think anything that helps to promote competition that helps to impact affordability for members, for plan sponsors, is a welcomed endeavor. So, you know, we're fully supportive that we're doing everything possible with our clients to drive value out of generics as they make their way to market and ensure that we're maximizing uptake of those generics wherever possible through things like step therapy and other utilization management edits, benefit designs, that encourage uptake of generic drugs. So as long as it's being managed in a clinically, appropriate high-quality manner, I'm all for it.

And I think it only will benefit the health system as a whole. We're under tremendous pressures right now, much of which is being driven by new entries into the specialty marketplace. That's only going to get more challenging as more and more gene and cell therapies make their way to market. The pharmaceutical industry is largely focused on rare and orphan disease now, so if it's not cell and gene, it's orphan. We know what the price tags are for these products as they make their way to market so we've got to have something to offset that in order to provide a well-rounded benefit and to ensure that the broadest number of patients who are appropriate candidates for these drugs have access to them. That's becoming more and more challenging for a lot of plan sponsors these days.