The first 2 years of the program created $26.9 million in cost savings and “biosimilar adoption rates that greatly exceed the US national average."
A recent article described strategic medication utilization management program initiatives undertaken by Providence St. Joseph Health, a large US non-profit health system, to increase biosimilar uptake and cut costs. The first 2 years of the program created $26.9 million in cost savings and “biosimilar adoption rates that greatly exceed the US national average.”
The author, Sophia Humphreys, wrote that biologics are a “key driver” of the recent increase in drug costs in the United States, citing a report stating that 43% of all US medication costs in 2019 were on biologics. Medication utilization management initiatives for biosimilars could then substantially reduce cost without compromising the quality of patient care. Humphreys described how Providence St. Joseph Health, a nonprofit health system consisting of 53 hospitals and 1085 clinics with an average of more than $1.2 billion spent on drugs per year, implemented a utilization management program to encourage biosimilar adoption.
The biosimilar adoption utilization management program included the following key components:
Identification of high-cost biologics with biosimilar alternatives. Analysis of drug spending by the health system revealed that the top 20 drugs by spending were all biologics, and accounted for about 40% of total drug spending.After evaluating clinical and pharmacoeconomic data and practical considerations related to these 20 drugs, the health system identified 7 biologics for the program that were nearing patent expiration: bevacizumab, epoetin alfa, filgrastim, infliximab, pegfilgrastim, rituximab, and trastuzumab.
Expedited formulary review process. Approvals of biosimilars to these originator biologics were “closely monitored” by the system’s pharmacy clinical service director. The health system made a change to their usual practices to allow their Pharmacy & Therapeutics committee to review all new biosimilars as soon as they gained FDA approval. The author noted, “due to this change in practice, all biosimilars were added to the system’s formulary before the biosimilars were commercially available.”
Pharmacoeconomic analysis. Analyses of drug costs, reimbursement, other treatment costs, infusion center labor costs, and patient assistance programs allowed the health system to choose a preferred biosimilar for each reference biologic.
Electronic health record tools to enhance operation efficiency. Electronic health record tools were designed “to efficiently guide prescribers to the system-preferred biosimilar product within each healthcare setting.” The author said these toolsstreamlined physician and pharmacist workflows and improved efficiency and standardization within the health system.
Communication and education. Prior to each switch to the preferred biosimilar from the reference product, all stakeholders were informed, including physicians, pharmacy teams, and distributors and manufacturers of the preferred biosimilars. In addition to health system stakeholders, the author wrote, patient education “is key to biosimilar program success.” Since there is still some patient uncertainty regarding biosimilars, Humphreys said, FDA biosimilar patient education tools were used to help patients understand the concept of biosimilars and promote biosimilar adoption.
Data-driven performance evaluation. Finally, an evaluation process was developed to measure spending on biologics, biosimilar utilization, and biosimilar adoption rates compared to the year prior to the start of each biosimilar initiative.
The biosimilar adoption initiatives were implemented for 4 biologics in 2019 and an additional 3 in 2020, leading to a savings of $26.9 million for Providence St. Joseph Health at the end of 2020. The cost savings were greatest for pegfilgrastim ($8.8 million); savings for bevacizumab, rituximab and trastuzumab were unavailable in 2019 and could only be evaluated during the second year. However, in 2020 alone, cost savings due to bevacizumab biosimilar use were estimated at $4.9 million.
High Biosimilar Adoption Rates
By the end of the second year, the average biosimilar adoption rate throughout the health system was 62%, ranging from 33% for infliximab to 74% for filgrastim.
Purchase of the reference products for the four biosimilars with initiatives implemented in 2019 was reduced on average by 64% after the first six months, ranging from 19.6% for infliximab to 92.8% for epoetin alfa.
The author noted that a successful biosimilar adoption program requires multidisciplinary collaboration between pharmacists, physicians, data scientists, finance analysts, business personnel and healthcare informatics professionals. However, Humphreys said, this collaboration on a comprehensive utilization management initiative produced important benefits: increasing acceptance of biosimilars, decreasing the cost of biologics for the health system, simplifying healthcare provider workflow, and reducing costs for patients while improving their access to care. Such programs, Humphreys proposed, “may play a significant role in optimizing affordable access to critical biologic drugs in US healthcare systems.”
Humphreys SZ. Real-world evidence of a successful biosimilar adoption program. Future Oncol. 2022;18(16):1997-2006. doi:10.2217/fon-2021-1584