Using Value-Based RA Pathway Leads to a Shift to Biosimilars for AHG

Biosimilars have struggled to gain ground in the United States, with few products launched, relatively low uptake of commercially available products, formulary restrictions that sometimes favor branded biologics over biosimilar options, and exclusionary contracting practices that block biosimilars from formularies altogether.

A variety of policy proposals have been put forward to help spur the US uptake of biosimilars, from legislative solutions to regulatory changes, but some providers are taking the matter into their own hands with concerted efforts to bring biosimilars to the clinic.

In an editorial appearing at the Articularis Health Group’s (AHG) website, Colin C. Edgerton, MD, one of the founding members of the rheumatology practice, explained that AHG has created a value-based rheumatoid arthritis (RA) treatment pathway that has boosted biosimilar use.

Using the American College of Rheumatology’s 2015 guidelines, the organization developed its value-based pathway with the goals of reducing costs for RA treatment while improving quality of care and patient outcomes. Edgerton explains that AHG collaborated with its largest commercial payer to model the pathway, then integrated the payer-approved pathway into its NexGen electronic health record (EHR) system in partnership with TSI Healthcare.

According to a June 2019 statement, TSI developed the logic of the integrated EHR tool to ensure that it did not impede providers’ workflow or create any new, unnecessary clicks; the tool supports rheumatologists’ adherence to the RA pathway’s evidence-based guidelines, thereby reducing the cost of care while maintaining physician’s autonomy.

As part of implementing the pathway and working with the payer team, Edgerton explains, the organization was able to negotiate biosimilars as first-line treatment for RA, overcoming a previous restriction from the payer’s formulary. “Our physicians may now prescribe the infliximab biosimilars Inflectra and Renflexis, or the originator Remicade, as first-line biologic therapy without the need for prior authorization. Indeed, the pathway program has eliminated prior authorization for any biologic agent,” writes Edgerton.

Biosimilars, he adds, are a “win-win for the practice, payers, and patient access,” and part of a shift toward biosimilar use at AHG has the result of holding meetings to review cost and utilization data for each prescriber. Many rheumatologists, he notes, were unaware that subcutaneous biologics result in higher spending than intravenously administered biosimilars, and prescribing habits have shifted toward biosimilars on the basis of better understanding of these costs.

Practice size has been a key factor in the success of the RA pathway, he writes, adding that rheumatologists may be constrained in their move to value-based pathways by their often small practice sizes. To help mitigate those constraints, AHG has launched the Articularis Rheumatology Network, which offers a group purchasing organization to allow members to purchase medications at discounts, and which offers the use of the value-based RA pathway program at zero cost.