This article from Benefits Pro argues that U.S. self-insured employers could have saved $1.4 billion and realized significant savings for their employees by promoting the use of biosimilars in employer-sponsored health plans.
The potential for biosimilars is tremendous, yet many employers continue to lose out on millions in savings. With nearly half of Americans relying on their or their family’s employers for health coverage, and as the costs of care rise in the US, employers should consider biosimilars as a viable solution to lower health expenditures and realize significant savings for their employees. In doing so, employers can also promote greater health system sustainability and access.
Actions for Employers
There are a few actionable steps companies can take now as they collaborate with PBMs and consultants to design benefit plans for next year.
Ask questions. Be prepared to ask tough questions of medical carriers, PBMs and consultants. For example, ask medical carriers for member data, information regarding available programs and where medical carriers are innovating on behalf of plan sponsors. Employers should consider hiring an expert pharmacy consultant and a rebate aggregator.
Develop a thoughtful plan design. This is key when looking to adopt biosimilars. Consider limited grandfathering to allow the use of existing medicines so as not to disrupt patients during their treatment cycle and ensure clear communication with members. Employers should also avoid a one-size-fits-all approach. Consider developing a strategy for each drug, its market dynamics, level of physician acceptance, and treatment situation.
Educate employees. Educating new and existing employees on their benefit packages is an important step for employers to help build confidence and trust in biosimilar medicines. Biosimilar information and education should be included in the company’s online and email communications, inclusive of potential cost savings, real-time benefit lookup tools and cost calculators that include biosimilars as available options.
Consider rebates. Rebates significantly impact the employer-sponsored health care arena, and they must be carefully considered. Employers should not be afraid to implement a lowest net cost without rebates strategy. If, however, a rebate model is used, the rebates should be reexamined regularly as the rebate landscape is constantly changing and employers will need to adapt the strategy to ensure the lowest net cost.