Expert: Leveraging AI to Improve Biosimilar Adoption and Cost Savings

In an interview with Pharmacy Times®, Josh Canavan, head of pharmacy at RazorMetrics, discusses how artificial intelligence (AI) can analyze biosimilar fill rates and identify potential issues in pharmacy claims. Canavan highlights the complexity of biosimilar prescribing, with physicians struggling to navigate different insurance formularies and multiple biosimilar options. The main goal is to use AI-powered tools to recommend the right biosimilar at the right dose, ultimately increasing adoption and cost savings.

Pharmacy Times

How do you see automation and technology like AI impacting the affordability and accessibility of biologics and biosimilars in the future?

Josh Canavan

There are many opportunities in this space. One of the great things about AI is it can ingest a large amount of data and then provide specific recommendations off that data. One example we're researching at Razor is utilizing AI to analyze biosimilar fill rates. When we look at pharmacy claims, we can see which ones are getting filled we can see which ones are getting picked up, and then, most importantly, we can see the ones that are getting what's called reversed — meaning the patient never actually walks away from the pharmacy with it. Utilizing AI, we can analyze, for the biologic, we're seeing these rates for the biosimilar, we're seeing potentially lower rates, and that can give us insights into potential issues. Why is that happening? Is it local problem? Is it nationwide? Is it specific biosimilars, and then we can solve for problems that we couldn't have done just by looking at the data ourselves.

Pharmacy Times

What are your thoughts on the potential of AI to identify patients who would benefit most from biosimilars and to streamline the process of switching them to these more affordable alternatives?

Canavan

Newer ideas are around an AI based prescribing decision support tool. Right now, we have real time benefit tools which utilize formulary data to try to recommend medications to the prescriber in real time. There's been low adoption for those it doesn't work really well and so utilizing AI to improve that process is going to be potentially huge. And so, what we can do is use AI within our existing technology stack to try to identify these patients. The main benefit of biosimilars for the payer and the patient is cost savings without any change to treatment. If we can use AI in this prescribing decision support tool to recommend the right biosimilar at the right dose that's covered on the formulary that doesn't require a prior authorization, then in the end of the day, we should be able to increase adoption and fill rates, and then also, ultimately, savings.

Pharmacy Times

Beyond cost, what other factors do you believe influence physician prescribing decisions regarding biosimilars?

Canavan

The biggest barrier for physicians is not knowing which biosimilar is covered. So, each patient has a different insurance company, each insurance company may have a different PBM, each PBM may have a different formulary, and so prescribers are faced with the idea that every person that walks into their office has a different requirement for what needs to be written, to be covered. If you take Humira a biologic, for example, it has 10 different biosimilars for it — just the one medication, including Amjevita, Hadlima and so all of these have different names that don't necessarily have anything to do with the reference product. So, you can't tell by the naming convention. Then only some of them are interchangeable at the pharmacy, so you have to write specifically for the biosimilar, for it to be filled sometimes. And it's unrealistic for us to expect prescribers to try to figure all of this out. They're extremely busy as well. They have limited time with their patients, and they don't want to spend it searching through formularies every single time to write from one of these. At the physician level, this is the biggest barrier they face.

Pharmacy Times

How can pharmacists stay informed about the latest developments in biosimilars and automation technologies to ensure they are providing the best possible care to their patients?

Canavan

There's a lot of great education materials out there. One of the best places to find it is on a website that's run by the National Library of Medicine, which is also run by the National Institute of Health. So, it's a government website, and it has a large database of clinical trials and articles. It's mainly known as PubMed. If somebody is looking for an easy way to search for something, typing in PubMed will get you there. Then within PubMed, you can search for anything you want. You can search for biologics, biosimilars. You can search for Humira biosimilars. You can narrow it down however you want. I just looked recently, and there are over 600 results for the word biosimilar just within the past year on PubMed. So, if you're looking for a lot of data, if you really want to dig in, you can definitely find it on that website.