Pharmacy benefit managers Due to their understanding of pharmacology , therapeutics and finances , a further important way in which pharmacists can become experts in biosimilars is by working as a pharmacy benefit manager ( PBM ). The PBM is a third-party health care plan administrator whose role is to manage benefits on behalf of payers through processing and paying prescription drug claims . A PBM will also work with manufacturers to negotiate rebates and discounts on behalf of payers and to use this information to develop and maintain drug formularies . In short , the role of a PBM is to offer programs that provide value and flexibility to payers to help control prescription costs . However , PBMs do not have a purely economic role and are involved in the provision of advice on therapeutic alternatives , evaluation of clinical programs , mail order services and medication management programs . Working as PBMs , pharmacists have a major role in the development of clinical policies to ensure appropriate biosimilar utilization which can potentially have a major impact on expenditure . For example , in 2019 , the PBM , Magellan Rx , reported a huge uptake in biosimilar use as a result of pharmacist input . The company ’ s pharmacists worked with clinicians as part of a utilization management initiative that focused on Inflectra ( an infliximab biosimilar ) used in the management of gastrointestinal and rheumatological diseases . A switch program , where patients were changed from infliximab to Inflectra , achieved up to 86 % biosimilar use . 5 In addition , according to the company , the switch program was able to achieve a 34 % reduction in drug therapy costs for health plan members . This example serves to clearly illustrate how pharmacists working collaboratively with clinicians can help drive biosimilar uptake and at the same
time , achieve significant cost savings . However , though pharmacists working as PBMs have much to offer in terms of driving biosimilar uptake and cost containment , this potential has yet to be fully realized . For instance , one study examining claims data from 2019 , revealed how US commercial health plans only covered biosimilars as their ‘ preferred ’ product in 14 % of decisions and biosimilar coverage varied across health plans . 6
Infrastructural change Once biosimilars have been adopted onto an organization ’ s formulary , pharmacist input is still essential to help manage the challenges that ensue from the necessary infrastructural changes required . Pharmacists need to develop best practice procedures to ensure that biosimilars are stored separately from the reference product in clearly marked bins . Pharmacy protocols should also ensure sufficient storage space both in the pharmacy and hospital units , particularly where an organization is required to keep several biosimilars because of different preferences among payers .
Electronic health records will also need to be updated to ensure compliance with the relevant naming convention for both reference products and biosimilars . Pharmacists will need to work on updating systems with unique identifiers for the different biosimilars and reference products , for example , using national drug numbers and lot numbers . These updates are crucial for patient safety and help to avoid dispensing errors , especially where several biosimilars are adopted by an organization . In addition , such measures will allow pharmacies to address any stock-outs , generate data for drug utilization reviews and minimize the risk of inadvertent switching for patients being either discharged or moved to in-patient facilities .
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