A series of initiatives to improve uptake of the biosimilars for 7 originator biologics resulted in significant savings for Providence St. Joseph Health.
While biosimilar uptake has been slow in the United States, a utilization management program designed to promote biosimilar use can successfully increase uptake and reap significant savings, according to a report published in Future Oncology.
While biosimilars have become widely accepted in Europe since the first one was approved in 2006, the United States has not been so quick to adopt biosimilars since the first approval in 2015. However, the first interchangeable biosimilars have been improved in the United States, which will allow a biosimilar to be substituted for the originator depending on the state.
Providence St. Joseph Health, a nonprofit health system based on Seattle, Washington, was successfully able to encourage the use of biosimilars instead of the originator biologics through the use of several tools, which saved the system $26.9 million over 2 years.
There were 7 components to the biosimilar adoption utilization management program initiatives, as reported by Sophia Z. Humphreys, PharmD, MBA, director of system pharmacy clinical services for Providence St. Joseph Health.
1. Identification of high-cost biologic medications with therapeutic alternatives. At Providence St. Joseph Health found the top 100 medications accounted for more than 70% of the annual drug spend and the top 20 drugs accounting for 40% of the entire drug budget were all biologics. The biologics targeted for the program were bevacizumab, epoetin alfa, filgrastim, infliximab, pegfilgrastim, rituximab, and trastuzumab, with an initiative for each of the 7.
Initiatives for epoetin alfa, filgrastim, infliximab, and pegfilgrastim were implemented in 2019 with initiatives for bevacizumab, rituximab, and trastuzumab being implemented in 2020.
2. Expedited formulary review process. The health system pharmacy created a simplified and expedited formulary review process for biosimilars based on the fact that approved biosimilars have to be highly similar to the originator products and have no clinically meaningful differences. The pharmacy and therapeutics committee reviewed biosimilars when the FDA approved them. “Due to this change in practice, all biosimilars were added to the system’s formulary before the biosimilars were commercially available,” the author wrote.
3. Pharmacoeconomic analysis: supported contracting decisions. The pharmacy clinical services and contracting team analyzed the pharmacoeconomic impact of candidate biosimilars in different health care settings before choosing a preferred biosimilar for each originator biologic. They did this because reimbursement differed in the settings. For instance, diagnosis-related group charges are the basis for reimbursement in the inpatient setting, but outpatient reimbursement is dependent on the patient’s payer and required prior authorization.
4. Electronic health record (EHR) tools to enhance operation efficiency. EHR prescribing tools streamlined workflows and simplified the biosimilar ordering process as well as guided prescribers to the system-preferred biosimilar product for all new prescriptions for the originator.
5. Communication. Prior to implementing the biosimilars utilization management program initiatives, all stakeholders in the health system were informed about the change to ensure a smooth implementation. The health system also notified distributors and manufacturers of the preferred biosimilars to avoid supply issues.
6. Education. The health system made FDA biosimilar patient education tools available and used them whenever application. “In addition to communication with prescribers, patient education is key to biosimilar program success, as there is still some patient uncertainty regarding biosimilar efficacy and safety,” Humphreys wrote.
7. Data-driven performance evaluation. To measure the biologic medication spend, biosimilar product utilization, and biosimilar adoption rates, a data-driven performance evaluation process was developed and assessed the performance of each initiative, monthly total spend, and savings comparing them to before and after the EHR tool was implemented.
Overall, the program saved $26.9 million over 2 years with $10.6 million in year 1 and an additional $16.3 million in year 2. The average biosimilar adoption rate across the health system was 62% (range: 33% for infliximab to 74% for filgrastim). Epoetin alfa originator had the largest reduction of purchases (–92.8%) and infliximab had the smallest reduction (–19.6%).
The total 2-year savings for each biologic was:
“The benefits of this program include a reduction in biologic medication spend, simplification of provider workflow, and improvement of overall health system financial sustainability,” Humphreys concluded. “The resulting cost savings and the increased access to care are expected to help improve overall population health outcomes.”
Humphreys SZ. Real-world evidence of a successful biosimilar adoption program. Future Oncol. Published online March 17, 2022. doi:10.2217/fon-2021-1584