I recently sat down to chat with Ned Pojskic, the leader of pharmacy and health provider relations for Green Shield Canada (GSC), a private, non-profit insurer. I was particularly excited to learn more about the role of the private payer in a country that offers government-funded healthcare for all citizens. I also wanted to learn more about GSC’s leading role in Canada’s growing biosimilar market. In a previous article, Pojskic shared how GSC was the first private insurer in Canada to place Inflectra on its formulary for rheumatology conditions. As if that wasn’t already notable, GSC recently launched its pilot biosimilar transition program for patients taking Remicade and Enbrel (rheumatology only).
But when Pojskic told me how GSC first selected Inflectra, I was struck by déjà vu. In the U.S., the slow progress of the biosimilar industry is often attributed to payer reticence and innovator contracting strategies. When Inflectra first arrived in Canada, GSC found itself at a similar crossroads as many U.S. payers. The innovator came forward with an alluring offer in order to keep its product preferred on the formulary. But GSC turned these offers down, choosing Inflectra — a controversial decision at the time. In the U.S., there are a number of ways manufacturers would like to see the payer formulary and contracting process changed to be more biosimilar-friendly. But outside the world of rebate traps, product bundling, and seemingly water-tight innovator contracting efforts, there is certainly still room for biosimilar manufacturers to improve their own payer strategies.
When I asked Pojskic what manufacturers could do to strengthen their relationships with payers (outside of offering the right price), he pointed out the importance of approaching payers early. In a lot of ways, biosimilar manufacturers in Canada were caught off guard because the innovator, facing biosimilar competition, had spent several years building up a dense reimbursement framework to make the originator product valuable to the market. “They really did their homework and put those deals out there, locking up the market before the biosimilar makers were even thinking about commercializing their product in Canada,” he said.
It’s a good practice for any product, not just originators or biosimilars, to approach the payer early — and in many cases, it needs to be much earlier than is typically done today. Quite often, the decision to commercialize a drug is made and the company begins to engage internal and external teams to research and develop the budgeting analysis. A company doesn’t approach the payer until the drug is a month or two — or even weeks — from a decision by Health Canada. The hope then is the payer will be able to turn around and list the product in two or three short months. The challenge here, however, is that the payer will not have had the opportunity to work with the sponsor and its clients to determine the final costs — especially for expensive biologic products.
Pojskic acknowledged manufacturers aren’t often able provide a large clinical picture of the product early on, especially as they don’t know the outcomes of Phase 3 trials. But the earlier a payer is aware of a product coming down the pipeline, the better they will be able to understand the implications of it for the market and their clients.
“I’d argue the moment a decision is made to commercialize a product, the manufacturer needs to reach out to the payer immediately, even if it’s only to share the big-picture estimates of the product,” he said. For instance, this could mean sharing as little as the general existence of the product in the pipeline, and that it will cost upwards of $30,000 a year and treat 10 million Canadian patients. “Much earlier engagement, even if it’s not fully formed, would be immensely valuable,” he offered.