Preferred drug strategy helps you control costs

With headlines like “no end in sight to rising drug prices External Site" in the news, you and your employees are probably struggling to keep up with the alarming prescription drug cost increases.

And, whether it’s choosing a pharmacy network, structuring your formulary, or marrying your medical and pharmacy benefits, you’re constantly on the lookout for ways to save money.

The good news? Pharmacy and drug innovation is an industry of constant change.

One new way to save money is including biologics and biosimilars in your tailored pharmacy benefit program. These products — designed to help control drug spending — create a sustainable health care system and achieve affordability for you and your employees.

What are biologics and biosimilars?

Biologics include a wide range of products, such as:

• Vaccines,
• Blood and blood components
• Somatic cells External Site
• Gene therapy External Site
• Tissues External Site
• Therapeutic proteins External Site derived from genetically engineered living cells or organisms and intended to prevent, treat, or cure a variety of medical conditions

Biosimilars are biologics like the original product with no meaningful differences in safety, purity, and potency.

The Biologics Price Competition and Innovation Act of 2009 created an abbreviated licensing process for these products to provide more treatment options, increase access to medications and lower costs due to more competition.

Today, biosimilars injected or infused by a provider are covered under medical benefits. In the future, biosimilars for self-administered biologic medications are anticipated and will be filled by a specialty pharmacy. The first self-administered biosimilar anticipated is Humira^® External Site, a popular used specialty medication that treats many autoimmune conditions, including rheumatoid arthritis, psoriasis and Crohn’s disease.

Safety and effectiveness

The U.S. Food and Drug Administration External Site (FDA) has declared biosimilars to be “safe, effective treatment options” while the American Cancer Society® (ACS) External Site states that depending on the drug, biosimilars might:

• Help immune systems recognize and kill cancer cells
• Work to stop cancer cell growth
• Make immune systems stronger

So, if an increasing amount of safe and effective biosimilars are hitting the market, how can you integrate them into your pharmacy benefit program for your employees?

Introducing biosimilars to your medical pharmacy program

Wellmark^® Blue Cross^® and Blue Shield^® has expanded our biosimilar strategy by adding a new specialty Biosimilar Tier which gives you an opportunity to lower the costs of preferred and non-preferred specialty drugs for your employees. This allows you to structure your pharmacy benefits to encourage your employees to use biosimilars by setting lower out-of-pocket costs for these products.

Wellmark’s biosimilar drugs and planned effective dates

Below are the drug classes included in our new tier and the timeline.

*Your employees will not need a prior authorization (PA) from a doctor if the drug doesn’t have one in place today.

Is a biosimilar drug strategy right for you?

Find out more about how a biosimilar drug strategy can help you control costs by talking to your Wellmark representative, or email us at blueatwork@wellmark.com Send Email. We'll walk you through the latest pipeline report and the impact these new drugs can have on your bottom line.