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)

Subscribe Today!

Apple Podcasts

Spotify

YouTube

RSS Feed

Medication management remains a critical focus for accreditation, quality, and patient safety. This episode features highlights from a recent Vizient and Joint Commission live broadcast exploring updated medication management standards, National Patient Safety Goals, and key survey observations affecting healthcare organizations today. Dr. Robert Campbell from Joint Commission and Diana Scott from Vizient join host Carolyn Liptak to discuss why standards evolve, emerging areas of risk, and practical insights to help organizations strengthen safe, high-quality care.

Guest speakers: Robert Campbell, PharmD, BCSCP Vice President, Accreditation/Certification Program Development and Accreditation Management Medication Safety Division of Accreditation and Certification Operations Joint Commission

Diana Scott, MHA, RN, CPHQ Principal, Regulatory and Accreditation Services Vizient

Host:  Carolyn Liptak, MBA, BS Pharm  Pharmacy Executive Director, Regulatory Compliance  Vizient Center for Pharmacy Practice Excellence

Show Notes:

[01:09] Updates to the Joint Commission standards and the focus on relevance, usefulness, and patient safety.

[02:13] Joint Commission replaced national patient safety goals with national performance goals. How medication management connects to other goals involving patient identification, care delivery, and health professional resource management.

[03:22] Looking beyond the number of findings to evaluate their potential impact, degree, and scope. A single observation can reveal a significant system or process failure requiring immediate attention.

[04:05] Multiple observations may now be grouped under one requirement for improvement, but each observation still requires correction.

[04:55] The three criteria used to identify an immediate threat to health or safety and taking action as soon as potential risks are identified during a survey.

[06:06] The difference between mitigation and abatement when addressing an immediate threat to health or safety.

[07:04] Situations in which Joint Commission may return within 23 calendar days to evaluate whether an issue has been corrected.

[07:38] Common concerns with titrated medications, including documentation that does not align with the most recent medication order.

[09:03] Medication safety responsibilities that extend across pharmacy, nursing, prescribers, procedural areas, and other departments.

[09:32] Sterile compounding concerns involving aseptic technique, hygiene, personal protective equipment, and environmental conditions.

[10:20] Immediate use compounding and the importance of distinguishing it from other preparation activities.

[10:46] Labeling medications and solutions in syringes, basins, bowls, cups, and other containers in procedural areas.

[11:18] Proper labeling as a simple but essential safeguard in fast-moving care environments.

[11:24] Medication management is a complex system that requires collaboration across multiple departments.

[12:11] Looking beyond requirement for improvement counts to evaluate the risks and scope behind each finding.

Links and Resources:

Joint Commission Medication Management Update 2026 – Vizient On Demand Webinar

Joint Commission Standards and Elements of Performance: Medication Management

Subscribe Today!

Apple Podcasts

Spotify

YouTube

RSS Feed