Treating patients with rheumatic diseases often involves using biologic medications, including biosimilars. Navigating health insurers’ policies and educating patients on the benefits of the different medications can be tricky, however. So explains Karen McKerihan, MSN, NP-C, in “Biologics & Biosimilars in Rheumatology,” a new policy brief from the Alliance for Patient Access.
Biosimilars are follow-on versions of an innovator biologic medicine. They come to market after the original and carry a lower price. Biosimilars can help patients effectively manage different rheumatic diseases, while also giving patients and providers more options for an optimal treatment path.
Patients often have questions about biologics, biosimilars, the difference between the two, and the rationale behind the specific medication they use. This is especially true when patients switch between treatments, McKerihan explains. Nurses are responsible for sharing information about biosimilars with their patients, from answering questions about efficacy and cost to explaining the clinical benefits of biosimilars.
Nurses need to be equipped with concise, up-to-date information on biosimilars and the applicable health insurance policies, McKerihan emphasizes. But when insurers change their policies with no warning, patients and nurses are left struggling to fill the gaps in both care and patient understanding.
Patient-Centered Care or Insurer-Controlled Decisions?
While biosimilars were intended to give patients more options, insurance companies may instead take the opportunity to optimize profits by driving patients to a single preferred medication. Patients may experience:
- Prior authorization. Insurance companies may delay treatment before a patient has permission to receive their prescribed medication.
- Step therapy. Insurers may require patients to fail other medications before their prescribed medication is covered.
- Non-medical switching. Insurers may eliminate coverage for one treatment and force patients to switch to a different agent.
Expanding options should encourage patient-centered care, but that isn’t always the case with current insurer practices. When used effectively, McKerihan explains, biologics and biosimilars provide patients with optimal treatment options. And as patients with rheumatic disease continue to rely on these medications, nurses will be there every step of the way.
To learn more, read “Biologics & Biosimilars in Rheumatology.”