During the past few weeks, I’ve jumped headfirst into a series on perhaps one of the most overlooked stakeholders today in the biosimilar industry: the employer. I wanted to learn where (and if) biosimilars figured into any of the nonprofit employer groups’ ongoing educational and outreach efforts, and how the biosimilar industry could help. Following my first interview with an expert from Employers Health, I was happy to hear that, at least as far as the nonprofit employer organizations were concerned, biosimilars are on their list of topics to watch closely. However, what became clearer to me with each subsequent interview is that biosimilars are only one of easily a hundred (or more) topics that are critical for employers to keep their sights on, including the most front-and-center concerns: healthcare reform, mental health, drug pricing, obesity, opioid abuse, cancer, and diabetes.
The amount of juggling employers have to do today was something Margaret Rehayem, the director of initiatives and programs for the National Alliance of Healthcare Purchaser Coalitions (National Alliance), kept returning to throughout our conversation. “The minute you step into the pharmaceutical space, you’re talking about a wide variety of things as far as employers are concerned,” she shared. “Employers need to make a number of decisions when determining benefits coverage. Being informed on healthcare trends that impact costs as well as the value of benefits is critical. To be effective, employers will need to understand the value proposition of biosimilars and other specialty drugs so they can better partner with their health plans and pharmacy benefits managers [PBMs].”
In addition to learning about the biosimilar-related activities National Alliance has implemented recently, I picked Rehayem’s brain about which educational strategies would best reach employers during this age when the entire U.S. healthcare system is under the microscope.
How National Alliance Is Approaching Biosimilars
National Alliance is the umbrella organization for upwards of 45 nonprofit employer organizations across the country, including the aforementioned Employers Health, the Midwest Business Group on Health (MBGH), and the Pacific Business Group on Health. Altogether, these organizations represent 12,000 healthcare purchasers (public and private employers, nonprofits, and Taft-Hartley groups) and about 45 million Americans with healthcare spending estimated at more than $300 billion. National Alliance is responsible for representing these coalitions at the national level, as well as supporting a number of key initiatives that have rolled up coalition efforts.
Rehayem, who worked with the MBGH prior to joining National Alliance two years ago, has been involved in the employer coalition and specialty pharmacy space for a while. While working at MBGH, she was part of the senior team that raised employer awareness of the specialty drug “tsunami.” This resulted in an MBGH employer toolkit on the specialty drug market that introduced biosimilars. Now, at National Alliance, she has worked with member coalitions to continue to educate employers on how best to address the many challenges of managing specialty drugs.
“We’ve developed a five-rights framework and a collective agenda that encourages action from all healthcare stakeholders,” she shared. “The goal of this framework is to highlight the issues surrounding the supply chain and address what needs to be done to solve these issues.”
When it comes to familiarity with biosimilars, Rehayem argued that, for the most part, employers remain in the dark about biosimilars, hence National Alliance’s growing educational emphasis on the topic. In July, the organization launched a webinar on biosimilars, which communicated the importance of these drugs in treating complex diseases such as cancer and rheumatoid arthritis at a reduced cost from their biologic counterpart. The following month, National Alliance published and distributed an action brief amongst its coalition members. This brief walks employers through the value of biosimilars and outlines specific questions they can ask their vendors regarding the integration of biosimilars into their healthcare strategy. (I’d urge you to take a look at this brief to learn how employers will be approaching biosimilars in their healthcare benefits management.)
But National Alliance’s biosimilar efforts are also geared toward supporting an ongoing evolution of PBM-employer relationships. “I think employers want to be more informed,” Rehayem explained. “These drugs are coming into the marketplace as employers seek more value for their investment. They aren’t just looking for rebates anymore. They want higher quality value-based care.”
There are some savvy employers who ask the hard questions of their consultants and brokers and others that go directly to their health plan or PBM to request changes to their contracts. Some companies are requesting access to medical claims data to get a better picture of their overall spend, while others question the idea of even having a formulary. Rehayem sees these changes rippling through more and more employers. In general, employers are moving towards addressing the larger systemic challenges, but need to remain persistent to have their needs met.
“We need to have a fresh conversation about the challenges we are facing in the healthcare system and get away from pointing fingers about who created the problem in favor of looking at real solutions,” Rehayem said. “Over the last few years, the National Alliance has been bringing employers and other healthcare stakeholders together to have those conversations.”
How Can Biosimilar Makers Enter The Conversation?
One way healthcare stakeholders, including biosimilar companies, can become more involved with supporting the employer community is by joining National Alliance’s National Health Leadership Council (NHLC). The council is a multi-stakeholder organization comprising members of health plans, employer organizations, drug makers, and advocacy organizations. Throughout the year, these stakeholders meet to discuss industry trends and challenges and to establish agendas confronting larger healthcare challenges. By joining organizations like the NHLC, biosimilar companies can become more strategic at the national level while also engaging employers at the regional level.
But from an educational perspective, there is a long way to go until information about biosimilars is widespread. As Rehayem emphasized, given the sheer volume of topics that come up in the healthcare space, biosimilars may simply be perceived as a “flavor of the month.” Similarly, education doesn’t just end with employer groups; many consultants and brokers — upon which employers rely for help negotiating their healthcare contracts — are also likely to be uneducated about biosimilars. (This knowledge gap is likely to persist as well, given the unavailability of pharmacy-distributed biosimilars for Humira and Enbrel.)
While Rehayem expects education on comparative effectiveness will lead to greater employer advocacy over time, ultimately, it’s going to come down to manufacturers presenting this information through many pathways so that employers stay informed.
For example, case studies detailing how employers have put together and successfully integrated biosimilars into their health benefits could be a critical source of information. In fact, National Alliance and Pfizer teamed up on a webinar about biosimilar use in a hospital system, which was well received. However, the real ticket in the future will be to share examples of how employers of different sizes and in different industries are able to implement biosimilars. As is the case in many industries, employers want to hear about what other employers are doing. For example, one experience just begging for future case studies is the switching pilot program being carried out in Canada by one non-profit payer and several employers. Should similar initiatives occur in the U.S., it would behoove a biosimilar company and an employer (or several) to share their story, process, and ongoing progress with the program for other employers.
Another way Rehayem suggested was to have biosimilar makers provide non-branded educational documents that could be used as part of employers’ larger healthcare conversations. “Information about biosimilars is more likely to have an impact if it’s folded into other issues of importance to employers — for example, formulary management or consumer education on how to best use certain drugs,” she said. “Information on biosimilars could easily fit within resources on those topics.”
Biosimilar makers also need to figure out how they can get their drug-related information vetted and included in vendor health databases so that employers can access the information as they would any other medical educational material.
In the end, biosimilar companies will need to be savvy in their approach to educate on what these drugs are and their impact on an employer’s healthcare strategy. As more biosimilars come into the marketplace over the next several years, the more an employer knows, the more they can drive change to support the health needs of their population.