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I often hear my patients ask the same questions: Why do I need to change to another infusible biosimilar again? Why do I need to get my infusion therapy sent by a specialty pharmacy? Will I be able to continue my therapy on time?
The answers are not straightforward. The story begins in 2016 when the first biosimilaropens in a new tab or window came to market in the U.S. Biosimilars are near identical copies of the original therapy with the same active ingredient, mechanism of action, and risks -- but they cost less. They are made to be interchangeable with the original therapy. While this sounds reasonable at face value, the issue stems from onerous requirements implemented by insurance companies and pharmacy benefit managers (PBMs) mandating use of very specific "preferred" therapies. I've seen the consequences firsthand at my community practice that provides infusion services.
My patient Savannah* is a classic example. She has ulcerative colitis, a chronic condition that causes inflammation in her colon. It took quite a bit of time until we found her the appropriate infusion therapy and dosing schedule to get her into remission and feeling well. Savannah's insurer subsequently required her to change to another biosimilar. However, the required prior authorization was repeatedly denied, which delayed her therapy and risked disease recurrence.
The answers are not straightforward. The story begins in 2016 when the first biosimilaropens in a new tab or window came to market in the U.S. Biosimilars are near identical copies of the original therapy with the same active ingredient, mechanism of action, and risks -- but they cost less. They are made to be interchangeable with the original therapy. While this sounds reasonable at face value, the issue stems from onerous requirements implemented by insurance companies and pharmacy benefit managers (PBMs) mandating use of very specific "preferred" therapies. I've seen the consequences firsthand at my community practice that provides infusion services.
My patient Savannah* is a classic example. She has ulcerative colitis, a chronic condition that causes inflammation in her colon. It took quite a bit of time until we found her the appropriate infusion therapy and dosing schedule to get her into remission and feeling well. Savannah's insurer subsequently required her to change to another biosimilar. However, the required prior authorization was repeatedly denied, which delayed her therapy and risked disease recurrence.