Presenters: Jenny Li, PharmD, BCPS, BCOP, American Oncology Network; Bradley Winegar, PharmD, American Oncology Network, Fort Meyers, FL
Co-Authors: Brooke Peters, PharmD, BCOP; Robert Carr, PharmD, BCPS, BCOP; Camilo Rodriguez, CPhT-Adv, CSPT, PRS; Ashley Kohler-Gerber, CPhT, CSPT; Darell Connor, MHA, FWSPA; Ta’Qyra Freeman, CPhT, CSPT; Kyle Brown; Melody Chang, RPh, MBA, BCOP, American Oncology Network, Fort Meyers, FL
BACKGROUND: Providers, payers, and patients all stand to benefit financially from the selection of the most cost-effective biosimilar drugs. As of September 2022, 22 of the 39 biosimilar approvals in the United States are for the treatment of cancer or for the supportive care of patients with cancer. Our organization is a network of community oncology practices, representing 107 physicians at 76 locations across 16 states. Because our network faces formulary selection and reimbursement challenges related to a diverse payer mix across multiple states, we studied the use of regional clinical pharmacists (RCPs) to assist with the selection of the most cost-effective biosimilar drugs.
OBJECTIVE: To assess the impact of using RCPs to assist with the selection of the most cost-effective biosimilar drugs.
METHOD: In October 2021, our network initiated a pharmacist-driven biosimilar drug substitution program, whereby the RCP acts as a liaison between providers and financial teams to evaluate existing drug orders and their financial impact. The RCP requests biosimilar switches in the electronic medical record (EMR) for financial review. Once approved, the provider confirms the acceptance of the switch and signs off on the order in the EMR. This study evaluated our network-preferred biosimilar drug uptake and associated cost-savings data from April 1, 2021, to April 1, 2022. The outcomes related to biosimilar use, as well as financial impacts on payers, patients, and providers, were assessed before and after the implementation of the RCP-driven biosimilar substitution program.
RESULTS: At the end of the study period, preferred drug use was achieved for >90% of bevacizumab, trastuzumab, rituximab, and filgrastim orders. The use of the preferred pegfilgrastim drug increased from <20% to >60% during this study period. Switching to a preferred biosimilar agent occurred in 26% of these cases. Payer preference prevented biosimilar switching in 34% of cases. Payer savings were approximately $29 million over the 6-month period before the implementation of the RCP-driven biosimilar substitution program and were $47 million over the 6-month period after implementation. The patient savings were estimated to be approximately $9500 before implementation and $30,000 after implementation. Provider savings were approximately $44 million before the implementation of the RCP-driven biosimilar substitution program and $90 million after the implementation.
CONCLUSION: The use of institution-preferred biosimilar drugs increased across all agents in this study after the implementation of the RCP-driven biosimilar substitution program. Significant cost-savings were noted for providers, payers, and patients. Barriers to switching to institution-preferred drugs included nonmedical switching requirements by payers, patient-assistance and compassionate-use programs, and patient and/or provider preferences.