Biosimilars, Gene Therapy and Cell Therapy: Greg Baker PBGH ’23 Webinar Series 3

In the third installment of the PBGH ’23 webinar series, the spotlight was on biosimilars, gene therapy and cell therapy. Greg Baker, CEO of AffirmedRx, dove into the details surrounding these medical terms, shedding light on crucial aspects employers need to comprehend while giving insights into the market dynamics and involvement of Pharmacy Benefit Managers (PBMs).

Eager to dive into the specifics? The presentation slides reviewed in this webinar are available at the link below:

1. Understand what Biosimilars Are

One of the primary challenges in the PBM space is deciphering the difference between biosimilars and generics. Greg Baker emphasized the importance of clarity, encouraging employers to grasp the distinctions and understand what is interchangeable within drug classes. By defining biosimilars, employers gain a comprehensive understanding of their functioning and their position in today’s market.

2. Formulary Placement of Biosimilars in the U.S. and the Market Forces Impacting Biosimilars

With a solid understanding of biosimilars comes the critical consideration of formulary placement. PBMs often interpret and use definitions in unique ways, making it imperative that employers know what to look for and the right questions to ask. Knowing that biosimilars are properly defined in their specific context offers insights into market forces influencing their placement within formularies and the way PBM contracts pay employer rebates.

3. Understand Cell and Gene Therapy

Expanding into a commonly asked question, Baker discussed cell and gene therapies – an area at the forefront of many employers’ minds. Over the past two years, we’ve engaged in a national dialogue about numerous products with curative capabilities. However, Baker addresses that our existing payment mechanisms are not tailored to accommodate the substantial costs associated with these ultra-high-cost therapies. Baker further discusses the projections of the gene therapy pipeline over the next several years and how that will impact employers.

When working with and assessing your PBM plan, staying informed about what these are, how they’re defined and the right questions to ask is vital to optimize health care benefits and make the best decisions for your member population.