Health New England says it achieved 93% utilization by requiring prior authorization.
A nonprofit health plan in Massachusetts recently said it has saved $1.7 million over the past year since emphasizing use of biosimilar infliximab, reaching 93% utilization in collaboration with Magellan Rx Management.
Health New England said its medical pharmacy program began the initiative on January 1, 2019.
“We were looking for ways to drive cost savings in this class without compromising patient care,” said Andrew J. Colby, RPh, MBA, Health New England's pharmacy director, in a recent statement. “Biosimilars offer an important opportunity to reduce costs for both payers and patients, while ensuring patients can continue treatment with a product that provides the same levels of clinical efficacy and safety they have experienced while taking the innovator drug.”
The reference product, Remicade, remains the highest-spend drug on the medical benefit, the company said. Biosimilars can cost as much as 35% less than originator products, the company noted.
Payers spend approximately $43,000 per patient annually on this product, and expenditures have continued to grow, including a 14% increase in Remicade per-member-per-month (PMPM) spend for commercial health plans from 2016 to 2017, according to Magellan.
Autoimmune PMPM drug costs are expected to increase 90%, from $1.40 to $2.66, by 2022 Magellan noted in last year’s Medical Pharmacy Trends report.
Working with Magellan, Health New England said it turned to a prior authorization program to drive utilization to biosimilar infliximab, with pharmacists using “the most updated peer-reviewed literature to develop a robust clinical policy.”
“We were able to collaborate with our provider network to ensure a smooth transition to the biosimilar product while providing patients with the same quality of care,” said Colby. “Our positive experience with this effort further supports similar initiatives for other therapeutic categories, such as oncology, in mitigating rising medical benefit trend and spend.”