Biosimilars have introduced new opportunities to reduce the disproportionately high US healthcare spending on biologic medications. This article describes strategic utilization management program initiatives designed to promote biosimilar utilization, reduce biologic drug costs and increase sustainability in a US nonprofit health system. Key components of these biosimilar utilization management program initiatives included expedited procedures to evaluate and establish the formulary status of biosimilars, enhanced contracting negotiations, specially designed electronic medical record tools to guide physician prescribing, payer coverage analysis, evaluations of biologic-utilization trends and financial performance analysis. Within 2 years (2019-2020), this program has resulted in savings of USD$26.9 million for Providence St Joseph Health and biosimilar adoption rates that greatly exceed the US national average.
Keywords: biologic drug cost; biosimilar; formulary; sustainability; utilization management.
Biologics are medications that are effective treatments for many patients but have a high price that affects patients and healthcare systems. Biosimilars are medications that are nearly identical copies to an approved biologic medication and have been shown to have similar effectiveness and safety. As biosimilars have a lower price than the bio-originators, the use of biosimilars can help reduce healthcare costs. This article describes how Providence St Joseph Health, a large US nonprofit health system, encouraged the use of lower-cost biosimilars instead of the higher-cost bio-originators. Using several different tools, Providence St Joseph Health ensured that biosimilars are used wherever possible and has saved USD$26.9 million in 2 years.