5 Slides: The policy implications of new medicines


Nicole Pasia


Panelists from multiple silos of biosimilar medicine came together to discuss how to increase the accessibility and affordability of these new medicines at State of Reform’s recent “5 Slides We’re Discussing” virtual conversation. 

The conversation brought together Karen van Caulil, Ph.D., President & Chief Executive Officer, Florida Alliance for Healthcare Value, Omar Rashid, M.D., Surgical Oncologist, Holy Cross Health, and Wayne Winegarden, Ph.D., Senior Fellow and Director, Center for Medical Economics and Innovation, Pacific Research Institute, along with State of Reform’s DJ Wilson. 


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During these virtual conversations, panelists share slides with research they wish to highlight. The first slide focused on research from PhRMA that shows over 12,000 current biosimilars and other new medicines in the clinical trial phase. A majority of these projects are potentially first-in-class, which means they treat a medical condition with a new and unique method.

From a policy perspective, Winegarden said our current drug payment system is “woefully underprepared” to deal with an influx of new medicines.

“We’re talking about therapies that are incredibly impactful … but it’s incredibly risky,” he said. “It’s incredibly costly to produce. We’re talking about numbers that are just incredibly expensive, incredibly high value, and our payment system is yesterday’s payment system … we need much better risk management on the health insurance side.”

In another slide, van Caulil drew upon a Fall 2021 survey of Florida Alliance for Healthcare Value’s business coalition members on threats to providing employer-sponsored health coverage. Based on the survey, van Caulil said drug and hospital prices were top concerns.

In an effort to find payment reform strategies that would increase access to biosimilars, van Caulil said several barriers are still in place. These include issues with prior-authorization of certain drugs or a “fail first” policy, which can require cancer patients to receive unsuccessful results from chemotherapy before accessing biosimilar treatment.  

Rashid commented on the direct impacts of these barriers on his cancer patients—many are more concerned about going bankrupt than the effects of their diagnoses. He also said patients struggle to find even basic screenings or treatment options.  

“Even for the person with great insurance, the system is so complex to be able to navigate … for us as clinicians, we’re developing these resources. We’re reaching out to the companies, we’re reaching out to the health systems and different community organizations to try to get those [navigation] resources available.” 

Improving system transparency, especially from health plans concerning where rebates for biosimilars go, could also lead to better access to these treatments, according to van Caulil. 

“It looks like the biosimilars, if we can get them in place, could be about 30% less than the reference product,” she said. “That should save [health] plans a lot of money. It’s been an uphill battle. I’ve been countering the incorrect information that’s been coming [to our members.]”

Watch the full discussion here