In December, ASBM recorded the seventh and final module in its biosimilar Continuing Education (CE) Course on Biosimilars, presented with the Ohio State University College of Pharmacy. The latest module is entitled “PBMs and Payer Practices” and is presented by ASBM’s Immediate Past Chair Madelaine Feldman, MD, FACR.
In this module Dr. Feldman explains unique features of the U.S. drug distribution system, with an emphasis on payer and pharmaceutical benefit manager (PBM) practices regarding biologic medicines and biosimilars. The bifurcated U.S. system (provider-administered vs. self-administered/pharmacy side) is examined in detail and the differences in these two sub-markets are highlighted: in particular, the degree to which savings can be achieved, and the role played by middlemen and manufacturer rebates in driving up rather than lowering costs. Utilization management tools used by payers (including non-medical switching and step therapy) are described, as are proposed regulations and legislation to restrict such practices.
- Discuss the role of pharmaceutical benefit managers (PBMs) in the U.S. drug distribution system
- Explain the effects of competition on drug pricing under provider-administered and patient-administered drugs.
- Identify several utilization management techniques used by PBMs to influence which medicine the patient receives.
- Describe concerns that patients and physicians have regarding these PBM practices.
- Discuss potential legislative approaches under consideration to address concerns with these PBM practices.
View all available modules of the ASBM/OSU Biosimilars Course here.