Pharmacy’s comfort with biosimilars is evidenced by their widespread adoption. While these products have yet to drive substantial cost savings, the expectation is that as more biosimilars enter the market, savings will increase. Nevertheless, the value of biosimilars cannot be realized on price alone, as reimbursement issues surrounding these products can be complex. Pharmacy must partner with revenue cycle teams and supply chain management to review outpatient pricing versus DRG reimbursement, as well as rebates, incentive contracts, and other mechanisms that impact the true cost of these products.
Despite the additional complexity involved in evaluating biosimilars for formulary inclusion, hospital pharmacy is increasingly receptive to these products; 79% of all facilities now include biosimilars on their formulary.
Pharmacy’s strong interest in biosimilars is projected to continue; 78% of facilities are planning to consider additional biosimilar adoptions as they become available.
Price and evidence-based clinical data are the leading factors driving the P&T Committee’s biosimilar inclusion decisions. It is notable that reimbursement has joined interchangeability as an increasingly important factor in the formulary process. Five years ago, just 50% of facilities were concerned with reimbursement during P&T review; now, 72% are considering reimbursement issues as part of the formulary decision.
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