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Specialty Pharmacy Continuum • May/June 2021
POLICY
Up to 70% adoption rates, millions in savings reported
Strategies for Boosting Biosimilar Uptake Use of biosimilars could increase if stakeholders, from manufacturers to payors and pharmacists, united to employ all the tools at their disposal, an expert told attendees of the 2021 virtual annual meeting of the Academy of Managed Care Pharmacy (AMCP). Hospitals and health systems that have taken part in comprehensive approaches to biosimilar utilization report enjoying full adoption of biosimilar use and saving millions of dollars every year, according to Catherine Pham, PharmD, MPH, a postdoctoral fellow in pharmacoeconomics and policy at Kaiser Permanente, in Los Angeles. “Education, communication and collaboration among stakeholders are key strategies to drive utilization of biosimilars,” Dr. Pham said. On the regulatory end of the stakeholder spectrum, the FDA and Federal Trade Commission took a step to address biosimilar adoption in early 2020, when they committed to working together to regulate false or misleading promotional statements regarding the drug class (bit. ly/3aOD1mX). As for the nature of the false or misleading claims, examples can be seen in a Citizen Petition that Pfizer sent to
Dr. Pham said such policies are more likely to succeed if providers have tools built into the electronic health record to guide prescribing and workflow. These tools and others, including therapeutic equivalence protocols, are most effective when developed by pharmacists in collaboration with providers, she noted. At Boston Medical Center, for example, pharmacy leaders established therapeutic equivalence for a switch from reference infliximab (Remicade, Janssen) to infliximab-dyyb (Inflectra, Pfizer) for inflammatory bowel disease (J Manag Care Spec Pharm 2020;26[4]:410-416). This protocol included gathering European and American clinical evidence on the efficacy of infliximab–dyyb, consulting with European providers about their
‘Education, communication and collaboration among stakeholders are key strategies to drive utilization of biosimilars.’ —Catherine Pham, PharmD, MPH the FDA in 2018. Pfizer, which manufactures several biosimilar products, including infliximab-dyyb (Inflectra) and filgrastim-aafi (Nivestym), cited statements by several reference biologic manufacturers which suggested that patients often react differently to biosimilars than to their reference products (bit.ly/3nJRIwV). The petition also cited a YouTube video that indicated switching between a biologic and biosimilar “is not a good idea if your medicine is working for you.”
What Providers Can Do For their part, providers can use formulary policies to encourage use of biosimilars, Dr. Pham noted. “A biosimilar can be officially preferred for use in treatment-naive patients, and policies can also be put in place to switch patients from a reference product to a biosimilar,” she explained.
experiences switching to the biosimilar, and documenting outcomes in their adult IBD patients after switching to the biosimilar and in those remaining on the reference biologic. The strategy resulted in a 97% switch rate to infliximab-dyyb.
What Payors Can Do Dr. Pham said payors can play their part in increasing uptake by using shared savings programs and other tools to incentivize biosimilars billed through the medical benefit. She anticipates more biosimilars to be processed through the pharmacy benefit in coming years and, for these products, “familiar strategies like formulary tiering, prior authorizations and step therapy requirements can be leveraged to place biosimilars on the same playing field as reference products.” Data from Magellan Rx Management, in Phoenix, demonstrated that step therapy is indeed one of the most
effective strategies that plans can use to encourage biosimilar uptake. “In our analysis, we’ve seen that plans that implement a step therapy policy at the time of biosimilar launch and that have also taken proactive steps like provider outreach, consultation with key opinion leaders, and having P&T committees develop biosimilar-first clinical policies have been able to take the greatest advantage of the savings potential of biosimilars,” Jim Rebello, PharmD, Magellan’s vice president of specialty strategy, told AMCP meeting attendees in a separate presentation. The analysis found that plans using step therapy achieved 68% and 70% adoption of biosimilar versions of bevacizumab and trastuzumab, respectively,
one year after their launch, and 39% uptake of biosimilar versions of rituximab in the nine months after launch. In contrast, plans without a biosimilar step therapy requirement had 13% and 16% uptake of biosimilar versions of bevacizumab and trastuzumab, respectively, and 9% uptake of biosimilar rituximab during the same periods.
Deep Discounts With the study showing 25% to 40% discounts for biosimilars compared with their reference biologics, plans that don’t use step therapy requirements and maximizing uptake would do well to reconsider their approach, Dr. Rebello suggested. “We’re seeing some natural uptake across all plans, but with a membership size of around 2.3 million lives, the plans with a parity policy are potentially losing out on around $30 million in annual savings.” —David Wild The sources reported no relevant financial disclosures.
