New Infliximab Biosimilar Program Soars to 93% Utilization at Health New England
“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. “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.”
Remicade®, the brand name for infliximab, is a drug used to treat autoimmune conditions such as rheumatoid arthritis and inflammatory bowel disease and remains the highest-spend drug on the medical benefit.1 Payers spend approximately $43,000 per patient annually on this product and expenditures have continued to grow, including a 14 percent increase in Remicade per-member-per-month (PMPM) spend for commercial health plans from 2016 to 2017.1 With the arrival of biosimilar competition in the United States in 2016, a new opportunity to drive cost savings appeared as the ingredient cost of biosimilars can be up to 35 percent less than the reference product.2
Health New England collaborated with Magellan Rx Management to implement a new program that leverages a comprehensive prior authorization solution to drive utilization to the lower-cost biosimilar versions of infliximab. In support of this initiative, a team of highly-trained pharmacists used the most updated peer-reviewed literature to develop a robust clinical policy. Magellan works with physician offices and hospitals to ensure appropriate utilization for each patient’s unique situation.
“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.”
12018 Magellan Rx Management Medical Pharmacy Trend ReportTM, ©2019.
2van de Vooren, K., Curto, A. & Garattini, L. Appl Health Econ Health Policy (2015) 13: 125. https://doi.org/10.1007/s40258-015-0154-9
About Health New England: Based in Springfield, Massachusetts, Health New England is a not-for-profit health plan serving members in Massachusetts and Connecticut. A wholly-owned subsidiary of Baystate Health, Health New England offers a range of health care plans in the commercial, Medicaid and Medicare markets. For more information, visit healthnewengland.org.
About Magellan Rx Management: Magellan Rx Management is a full-service PBM that expands beyond traditional core services to help its customers and members solve complex pharmacy challenges by connecting them to the people, technology and information they need to make smarter healthcare decisions. Magellan Rx Management is leading the next evolution of PBMs by using a value-driven approach that moves past the traditional volume-focused thinking to deliver true value-driven solutions, including targeted clinical programs, powerful member and provider engagement strategies, advanced analytics and expert specialty pharmacy management capabilities. Magellan Rx Management is a division of Magellan Health, Inc. For more information, visit MagellanRx.com.
Health New England
Source: Health New England