Presenting Author: Sidney Keisner, PharmD, BCOP, University of Arkansas for Medical Sciences, Little Rock, AR
BACKGROUND: To capture the projected savings associated with biosimilar agents, the University of Arkansas for Medical Sciences underwent biosimilar conversion to maximize their use. Preferred formulary biosimilars (PFBs) were chosen based on cost and reimbursement factors, and the conversion was implemented in phases for each product. The first phase involved changing the order set product defaults in the electronic medical record.
OBJECTIVE: The primary aim of the analysis was to assess the impact of the first phase of biosimilar conversion in the outpatient setting at our institution. Pre- and post-implementation comparisons were conducted. The end points were utilization rates of the new PFBs, markers of reimbursement, acquisition costs, and the reasons PFBs were not used.
METHODS: Formulations of bevacizumab, rituximab, and trastuzumab were included. End points were analyzed in pre- and post-implementation time periods, which were defined as 18 months before and after implementation with a buffer to avoid transition periods. Cost benefit was calculated from an institutional perspective as expected revenue divided by acquisition cost. To control for underlying cost trends, the preimplementation cost for each product was applied to drug administrations in the postimplementation period. For products used post implementation only, the cost observed in the first quarter of the postimplementation period was applied to all subsequent drug administrations. Drug administrations associated with medication assistance programs, open accounts, global payment agreements, and nononcology indications were excluded.
RESULTS: Compared with the preimplementation period, the use of PFBs significantly increased in the postimplementation period (bevacizumab, 1.5% vs 56.4%; rituximab, 7.5% vs 77.8%; trastuzumab, 3.6% vs 43.4%; P<.001 for all changes). The average cost benefit of each drug, regardless of formulation, significantly increased (bevacizumab, 2.08 to 2.19; rituximab, 4.17 to 5.26; trastuzumab, 3.00 to 4.73; P<.001 for all changes). The average acquisition cost per dose decreased in the postimplementation period, and the most common reasons PFBs were not used included incomplete order set conversion and payer preferences.
CONCLUSION: In the first phase of implementation, we observed a significant increase in the use of PFBs with improved financial indicators. The most common reasons PFBs were not used reflected incomplete implementation and expected payer preferences. Limitations of the analysis include changes in acquisition costs over time, payer preferences for PFBs, and grandfathering of nonpreferred products, all of which may lead to underestimation of the actual impact of biosimilar conversion in the postimplementation period.
- Mulcahy AW, Hlavka JP, Case SR. Biosimilar cost savings in the United States: initial experience and future potential. Rand Health Q. 2018;7:3.