Strategic biosimilar optimization can help health systems evaluate medication choices through a broader clinical, operational, financial, and payer-focused lens. Dr. Jerry Rebo from Novant Health joins host Heather Pace to discuss a structured quarterly process for reviewing biosimilar performance, monitoring payer preferences, identifying denial trends, and supporting informed therapy decisions. He shares practical guidance for health systems, building a similar approach with existing resources.

Guest: Jerry Rebo, PharmD, MBA, BCPS, BCCCPS, D-PLA Director of Value & Outcomes Novant Health

Host: Heather Pace, PharmD Senior Clinical Manager, Ambulatory Center for Pharmacy Practice Excellence, Clinical Spend Management Vizient

Show Notes:

[00:55]

• The challenges of managing biosimilars across clinical care, clinic operations, reimbursement, payer contracting, prior authorization, and patient experience.
• The factors Novant Health considers when evaluating biosimilar products and therapeutic classes.

[01:51]

• Novant Health’s structured four-week review process, beginning with data collection from studies, reimbursement reports, payer policies, denial trends, and margin analysis.
• The role of therapeutic class reviews, clinical feedback, operational considerations, and financial performance in developing quarterly recommendations.

[03:27]

• The purpose of a biosimilar payer table and the way it tracks formulary updates, payer preferences, documentation requirements, and denial trends.
• How payer information supports communication among medical teams, authorization teams, pharmacy teams, and informatics partners.

[04:52]

• The difference between responding to individual denials and monitoring denial patterns over time.
• The value of identifying whether denials are connected to internal operational issues or changes in payer policies and plans.

[06:49]

• How expected payment rates are calculated by comparing actual reimbursement with billed amounts.
• The importance of reviewing reimbursement performance regularly so product recommendations can be updated as conditions change.

[07:56]

• The challenges of identifying opportunities for optimization across different therapeutic classes and payer types.
• Why Medicare Advantage plans require additional review since their preferences may differ from standard Medicare formularies.

[09:36]

• The value of breaking down organizational silos and bringing pharmacy, revenue cycle, clinical, operational, and administrative experts together.
• How a systematic biosimilar review process may support future medication management efforts involving biologics, cell therapies, and gene therapies.

[10:53]

• Practical advice for health systems that want to begin a biosimilar optimization process with limited resources or staffing.
• The importance of connecting with colleagues, learning from related initiatives, and mapping existing workflows before building a new process.

[12:02]

• Opportunities to use automation and technology to reduce manual data preparation.
• The potential for more efficient tools to give teams additional time for analysis, recommendations, and implementation.

[13:16]

• The importance of building relationships across the health system to solve shared problems.
• The role of cross-functional collaboration in supporting successful biosimilar management.

Links and Resources:

Vizient 2026 Connections Summit (poster presentations will be available for viewing on Oct 7)

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