PBM Says Its Biosimilars Strategy Led to 86% Use of Biosimilar Infliximab

Magellan Rx Management, a pharmacy benefit manager (PBM), said today that its biosimilar management program has resulted in strong biosimilar uptake and significant drug cost savings for health plan organizations during its first year.

According to a statement issued by the PBM, the utilization management initiative, which focuses on the biosimilar infliximab product Inflectra, has allowed health plans that take a “comprehensive management approach” (one that switches all patients receiving infliximab for the management of gastroenterological or rheumatological diseases to the biosimilar infliximab product) to achieve up to 86% biosimilar use.

Health plans that have used a “softer approach,” under which only new patients are asked to use the biosimilar agent instead of the brand-name Remicade, have seen their biosimilar use climb to as high as 75%.

According to Magellan, the switch to biosimilar infliximab has saved its health plan members 34% in drug costs for the therapy.

The PBM added that as part of its initiative, it deployed a team of pharmacists to develop its clinical policy and to work with physician offices and hospitals to ensure appropriate drug utilization while respecting the unique needs of individual patients.

In a statement, Steve Cutts, senior vice president and general manager of specialty at the PBM, said, “These are difficult-to-manage therapies, but with over 16 years of targeted, total specialty drug management expertise, Magellan Rx—and our health plan customers—are in a prime position to embrace biosimilar availability of these high-cost drugs and produce real savings for all involved, not only through our clinically-sound utilization management program but also by negotiating enhanced discounts for the biosimilar versions.”

Cutts added that the PBM plans to take advantage of its early success with Inflectra as a means to tailor additional formulary management and clinical programs to drive biosimilar cost savings.

In a recent report, Magellan said that utilization management tools applied to biosimilars rose to prominence in 2018; during the year, 51% of payers required patients to use a biosimilar product first before using its reference (a controversial practice that contradicts guidelines in place in Europe, although not in the United States).

Of those payers not yet using step therapy for biosimilars, 36% were planning to do so, whereas 41% were not planning to implement such a strategy. Most payers (73%) indicated that a significant cost differential of between 25% and 50% would be needed before they would implement step therapy, and about half of payers said that they would implement a step if there were an FDA designation of interchangeability for a given biosimilar.