Ep. 85: Navigating Biologic Therapy – What You Need to Know
Part of the series: Allergy, Asthma & Immunology Innovations Podcast
This podcast was made in partnership with Allergy & Asthma Network.
We thank Sanofi-Regeneron for sponsoring this episode. While they support the show, all opinions are our own, and sponsorship doesn’t influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.
LISTEN TO EPISODE 85:
Starting biologic therapy can be life-changing, but navigating the process isn’t always easy.
Dr. William Anderson joins Dr. Gupta and Kortney to break down the essential steps for starting biologic therapy, covering everything you need to know before beginning treatment. Biologics are at the forefront of managing chronic allergic diseases like asthma and eczema, offering targeted, personalized care that can improve patients’ quality of life. However, accessing these medications often requires navigating a maze of insurance approvals, prior authorizations, and specialty pharmacies.
We dive deep into the challenges patients face when starting biologics—understanding how to get coverage, managing co-pays, and coordinating with specialty pharmacies, all while handling the logistics of administering the medication. As someone who has just started a biologic herself, Kortney shares her own experience and reflects on how this episode provides the exact information she wished she’d had a few months ago.
What we cover in this episode about starting a biologic medication:
Getting informed before starting biologic therapy: Dr. Anderson explains why reviewing your medication’s patient website is a great first step. These resources often include videos and important details about the treatment.
Navigating insurance and coverage: Insurance is often the biggest hurdle to starting biologics. Dr. Anderson highlights the role your doctor plays in this. Additionally, we discuss the importance of understanding your coverage, prior authorization, and working with specialty pharmacies to ensure you get the medication.
Administration and storage of biologics: Whether it’s self-injection or infusion at a clinic, we explain how biologics are administered. Dr. Anderson also provides tips on proper storage, including refrigeration and traveling with biologics.
Vaccines and biologics: Find out whether patients on biologic therapy should avoid live vaccines and how inactivated vaccines like the flu shot are generally safe to take.
Long-term planning for biologics: Learn about the regular follow-ups and monitoring that are part of managing biologic therapy. Dr. Anderson discusses the importance of staying on track with your doses and follow-up appointments to ensure your biologic works effectively.
About our biologics expert - Dr. William Anderson
Dr. William Anderson, is a board-certified pediatric allergist and immunologist at Children’s Hospital Colorado. With a focus on treating children with complex allergic conditions such as asthma, eczema, and food allergies, Dr. Anderson is known for his patient-centered approach. He has extensive experience in biologic therapies and is dedicated to improving the quality of life for patients through personalized care. Dr. Anderson also actively participates in clinical research, staying at the forefront of advances in allergy and immunology treatments.
More resources about biologic therapies and the conditions they treat:
Other episodes about biologic medicine:
Checklist: Things to consider before starting a biologic
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Confirm if your insurance covers the biologic.
Understand if prior authorization is needed.
Ask about co-pays and out-of-pocket costs for biologics.
Check if your insurance requires you to use a specialty pharmacy.
Explore financial assistance programs (manufacturer or non-profit) if your co-pay is high or insurance denies coverage.
Ask your doctor or pharmacist if ordering a three-month supply could reduce costs.
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Find out if a specialty pharmacy will handle your biologic.
Confirm how the medication will be delivered (to your home, local pharmacy, or work).
Ask the pharmacy if they offer training on how to use the biologic.
Ensure the pharmacy provides instructions for proper storage and handling of the medication.
Contact the pharmacy for any additional questions about your biologic.
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Determine if the biologic will be administered at home or in a clinic.
If self-administering, ask for training from your healthcare provider or the pharmacy.
Make sure you have the right supplies for self-injection, such as alcohol wipes, sharps container, etc.
Set up phone reminders or a schedule for your doses (biologics are usually taken every 2-8 weeks).
Know how to store your biologic (usually in the refrigerator) properly.
If traveling, plan ahead by using an insulated cooler or ice packs to maintain the correct temperature.
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Schedule regular follow-ups with your doctor to monitor your response to the biologic.
Be aware of common side effects, like injection site reactions or mild flu-like symptoms.
Ask if you’ll need blood tests or other monitoring based on your biologic.
Understand what to do if you miss a dose (contact your doctor for guidance).
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Ask your healthcare provider if you need to avoid live vaccines (e.g., MMR, chickenpox) while on biologic therapy.
Check with your doctor before getting vaccinated to ensure it’s safe with your biologic.
Inactivated vaccines (e.g., flu shot, and COVID-19 vaccines) are generally safe while on biologics.
Episode in a Nutshell: Starting Biologic Therapy Cheat Sheet
Insurance and Prior Authorization:
Many biologics require prior authorization from your insurance company.
Your doctor provides information to prove the biologic is medically necessary.
Contact your insurance to understand coverage, co-pays, and required pharmacies.
You may need to appeal if the request is denied initially—this is common.
Biologic manufacturers often offer financial assistance programs to help with costs.
Specialty Pharmacies:
Biologics are typically managed by specialty pharmacies rather than local ones.
These pharmacies ship medication directly to your home or nearby locations.
Specialty pharmacies offer training on how to self-administer biologics.
They can provide guidance on storage, and handling, and answer any medication-related questions.
Ask if ordering a three-month supply can lower costs or simplify logistics.
Administration of Biologics:
Biologics can be self-injected at home or administered in a clinic.
Store biologics properly, usually in the refrigerator. Avoid freezing them.
Stick to your dosing schedule and set phone reminders to avoid missing doses.
Plan ahead when traveling—keep biologics cool with insulated bags and ice packs.
Some biologics require a loading dose at the start to help them work faster.
Timestamps
Starting and planning biologic therapy - episode timestamps
01:50 Steps patients can take to inform themselves about biologics
03:18 Navigating insurance and biologic therapies
05:50 Understanding prior authorization
10:50 Shared decision-making considering the costs of biologics
13:52 The role of specialty pharmacies in biologic treatments
15:19 Refilling biologic medications
16:53 Understanding copays for biologic treatments
18:44 Administration methods and frequency of biologic medications
20:22 Delivery methods: auto-injector vs. pre-filled syringe
21:22 Importance of the loading dose in biologic therapy
23:03 Proper storage of biologic medications
26:11 Handling a missed dose of biologic medication
27:32 Guidelines for taking biologic medication early
28:26 Considerations for vaccines while on biologic therapy
32:42 Frequency of follow-ups with your doctor during biologic therapy
