PBCG takes a multifaceted approach when evaluating a biosimilar strategy. Our Pharmacy & Therapeutics (P&T) Committee in conjunction with our Value Committee ensures that all the FDA-approved indications of the reference product are included on the formulary, considers biosimilar interchangeability status, confirms that the biosimilar product is cost effective compared to the originator, and minimizes member disruption with strategy change. For 2023, the following biosimilars are included on both formularies:
PBCG is actively evaluating the strategic opportunity of multiple Humira biosimilars that will launch in 2023-2024. Ideally, expanded market competition with Humira biosimilars will help to drive down costs for reference products and competing biosimilars.
The non-essential drug (NED) program blocks the use of high cost and low clinical value FDA-approved drugs. Products are closely reviewed by our P&T Committee and if determined to have no clinical advantage over previously approved, more cost-effective products, the drug is added to the program with a clinically appropriate alternative.
For 2023, there is expanded management of 16 additional products. These products range from unique strengths of metformin, that can be up to 200 times the cost of existing generics, to new formulations of products like baclofen, that have generic products available. This program is continually reviewed and updated as new drugs are launched.
Looking ahead, Pharmacy Benefits Consulting Group will always ensure a member-focused approach to our formulary and drug management practices. While new medication entrants may offer cost reductions to our plans and members, it is imperative that our members have a smooth transition with minimal disruption to their disease state management. This discipline helps members achieve whole health for life while ensuring our customers minimize unnecessary costs.
