A Q&A with Matt Mitchell, AVP, Scripius Pharmacy Services
Samsung’s biopharmaceutical company, Samsung Bioepis, recently sat down with our Pharmacy Services AVP, Matt Mitchell, to pick his brain on biosimilars' strategy. Matt, PharmD, MBA, and FAMCP, is a recognized leader in the implementation and adoption of biosimilars. Published in Samsung Bioepis’ Third Quarter 2024 Biosimilar Market Report, Matt’s interview is included below. Matt explains the financial calculus, the obstacles of communicating a change to diverse audiences (e.g., prescribers, plan sponsors, and consumers), and what he has learned from Scripius’ most recent biosimilars move.
Samsung Bioepis: What were the main barriers your organization faced when deciding to remove Humira from your formulary?
Matt Mitchell: The biggest barrier when moving from Humira to biosimilars across all lines of business is the increase in workload for providers.
- For Commercial business, a significant challenge is transitioning members from a copay assistance program associated with Humira to a copay assistance program associated with a biosimilar. In addition, PBMs and payers unfortunately also need to consider rebate revenue and rebate guarantees to downstream clients.
- In Medicare, making a change was not as easy due to a more complex market and logistical difficulties with CMS filings. Despite the challenge, Scripius added adalimumab-atto and adalimumab-bwwd as preferred products while removing Humira effective January 1, 2024.
Samsung Bioepis: What measures were taken to support downstream physicians and patients in the transition to adalimumab biosimilars?
Matt Mitchell: Scripius has had a working relationship with key providers for years. We have a lot of biosimilar experience with infliximab in addition to oncology treatment and oncology supportive care. This experience helped set the stage for early conversations about the pending adalimumab biosimilar opportunities. Information was shared with key stakeholders, including physicians, ambulatory pharmacists, and specialty pharmacists around potential savings opportunities as well as roll out conversion strategies. One tool that was created by a client, Intermountain Health, was a Collaborative Practice Agreement (CPA)*. With the agreement in place, they were able to initiate a transition from the clinic or the specialty pharmacy directly to ease the transition process for patients.
* A CPA is unique and arguably the most effective tool to easily promote biosimilars. It allows a pharmacy to swap to another biosimilar without a prescription from the provider. The CPA gives authorization to that pharmacist/pharmacy to make those specific changes on behalf of the provider.
Samsung Bioepis: What were the main drivers for your organization to remove Humira and move forward with a pro-biosimilar strategy?
Matt Mitchell: There is no way around it, cost savings is the only reason to move forward with any biosimilar strategy. While Fee for Service Medicaid is different, Managed Medicaid plans almost always benefit from biosimilars due to low supplemental rebates available for reference brand drugs. Due to the upcoming change in Medicare with a maximum member contribution of $2,000.00, payers will concentrate on low-cost specialty drugs, such as biosimilars. Commercial business is a little more complex because more real-time, mid-year changes are options. Scripius will continue to capitalize on its ability to be very agile to optimize biosimilar options when there are savings available.
Samsung Bioepis: How effective has your organization been in the transition to adalimumab biosimilars?
Matt Mitchell: We have been very successful. Scripius worked with one of its clients, Select Health, to quickly transition 98% of their Humira prescriptions to one of the adalimumab biosimilars. We believe this was the fastest transition in the country. For our Commercial business that transitioned, biosimilars make up 99.9% of the market share of adalimumab products.
Samsung Bioepis: What key lessons has your organization learned from implementing this strategy?
Matt Mitchell: A key lesson is that it is important to over communicate a decision to move to biosimilars due to differences of strategy across different lines of business. Providers have the difficulty of seeing patients from a large variety of insurers so keeping up with different strategies is extremely difficult. Even more communication and early coordination with providers and pharmacy services would have made transitions quicker and smoother.
Samsung Bioepis: Based on this experience, is your organization more prepared and likely to adopt biosimilar strategies in the future?
Matt Mitchell: Absolutely! We have been able to improve operational efficiencies with the adalimumab biosimilar experience. Manufacturers, PBMs, and payers have been able to explore different strategy opportunities over the last 18 months. I expect biosimilar adoption to increase going forward with adalimumab, tocilizumab, ustekinumab as well as more upcoming opportunities.
Samsung Bioepis: What advice would you share with other payers who are hesitating to make a decision to transition to biosimilars?
Matt Mitchell: First, the net cost needs to make sense to make a switch to biosimilars. Second, manufacturers also need to have adequate supply. Third, make sure to outline processes early and work with all stakeholders to optimize a quick transition when necessary to achieve the lowest net cost.
You can download the full Third Quarter 2024 Biosimilar Market Report here.