Biologic and biosimilar drug products are coming to market at an increasing rate. But the costly therapies can be complex to manage and process for payers without the right resources.
The challenges of managing data
In efforts to improve both business and member outcomes, payers are searching for ways to pull together disparate data sources to create a holistic member record from clinical, pharmacy, and claims data.
The inherent challenge that many payers face, explains Allison Combs, Head of Product - Payer, for Clinical Effectiveness at Wolters Kluwer, Health, is that there isn’t always data alignment with partner organizations such as pharmacy benefit managers (PBMs) or consultants that support both markets.
When major pharmacy trends or innovations change the landscape of drug therapy, standardized drug data can be an important tool in helping payers navigate critical formulary, member care, and claims decisions, as well as evaluate and identify opportunities, explains Karen Eckert, MPM, RPh, Associate Director, Technology Sales Support, for Clinical Effectiveness at Wolters Kluwer, Health. With margins being compressed, PBMs and payers need a strong data approach to look for operational efficiencies to drive outcomes and effective decision-making, Eckert says.
Drug data and the complexity of managing biosimilar therapies
One of the key payer drug data needs is to help manage biologic and biosimilar therapies. Due to the complexity of identifying and grouping these products and understanding therapeutic substitutions, keeping pace with the evolving landscape of biosimilars and having data resources detailed enough to build effective formularies is essential for payers.