From biosimilars to PLAs: Panel addresses hot topics in drug plan management

From biosimilars to product listing agreements, a panel of experts tackled some of the hottest topics in drug plan management at the Face to Face Drug Plan Management forum on Dec. 14.

Barbara Martinez, who heads up the national drug benefits solutions practice at the Great-West Life Assurance Co., addressed the question of biosimilars during the panel at the annual event. She said that while the use of the products has the potential to produce savings for plan sponsors, uptake has been slow in Canada so far. “There’s pressure on us to rush to force everyone onto a biosimilar. But doctors aren’t prescribing them, and patients don’t understand them. I don’t think the market is ready to have one strategy,” said Martinez.

“We need to have different strategies, depending on the biosimilar itself and who the originator is,” she added.

Read: The great pharmacare debate: An ‘overly simplistic’ solution or needed system rationalization?

Durhane Wong-Rieger, the president and chief executive officer of the Canadian Organization for Rare Disorders, agreed, saying that a slow and patient-centred approach would help to get the most out of biosimilars.

Certain patients will be more open to trying other treatments than others, depending on the disease they suffer from, as well as individual differences, she explained.

And there are risks if cost becomes the only factor driving the use of biosimilars, according to Wong-Rieger.

“I am worried, down the road, that we are going to have only a drive to the lowest-cost biologics,” she said. “All of a sudden, we’ll find we’re in the situation we have with some of the generics, where people fall out of the market and we end up with less-quality products.”

Cory Cowan, the director of professional services at Telus Health, described the emergence of biosimilars in Canada as a “welcome addition to the available options” for plan sponsors that’s creating additional competition in the marketplace. Despite the promise of the products, the uptake so far has been low, he noted.

As the market develops, Suzanne Nagy, the drug consulting leader at Mercer Canada, predicted that biosimilar strategies would become as important to plan sponsors as those involving the use of generics. For now, though, she said employers are still getting their heads around the idea.

Read: Private plans to see drug costs rise by 6.1% annually over next five years

“They somehow got the impression they have to pick a biosimilar strategy or a product listing agreement but they can’t have both,” said Nagy. “We’re encouraging clients to cover both ends of a drug life cycle, so that they have a biosimilar strategy to protect the plan with older molecules that have lost patents, as well as having access to PLA pricing for the newer molecules.”

Nagy added that some plan sponsors also struggle with the existing model for product listing agreements and would prefer to access collective bargaining power through the pan-Canadian Pharmaceutical Alliance, which currently conducts negotiations for drug prices with manufacturers on behalf of the federal government and all 13 provinces and territories.

“It would be fairly easy to understand, and even if the price was confidential, plan sponsors would be confident that they are getting the lowest price for that drug in Canada,” said Nagy.

Read: Options for getting the best value from drug plan spending

But Joe Farago, executive director of health-care innovation at Innovative Medicines Canada, said if plan sponsors and insurers became part of the alliance, it would significantly delay their ability to get drugs to their members.

“If a drug is $1 a day or $1,000 a month, you would still be required to wait, on average, 12 to 18 months,” he said. “There is no way to accelerate expensive or inexpensive drugs through that process.”

On the subject of product listing agreements, he said manufacturers and insurers might choose to enter into negotiations directly. They can offer plan sponsors the opportunity to differentiate their drug plans from public programs, he noted.

“Having those specific agreements can allow more flexibility to create some solutions that are tailored to meet the market’s needs now and in the future,” said Farago.

Read more stories from the Face to Face Drug Plan Management Forum