Health Plan Saved by Switching from Cosentyx to Taltz

Switching a small number of patients from Novartis’ Cosentyx (secukinumab) to Lilly’s Taltz (ixekizumab) was able to save a regional health plan about $800,000, according to a poster presented at the annual meeting of the Academy of Managed Care Pharmacy held in Chicago, from March 29, 2022, to April 1, 2022.

Beginning October 2019, the Group Health Cooperative of South Central Wisconsin replaced Cosentyx with Taltz as the preferred targeted immunomodulators, which are monoclonal antibodies used to treat plague psoriatic arthritis, plague psoriasis, and ankylosing spondylitis. The two therapies have similar clinical profiles. Both bind to the proinflammatory cytokine IL-17A and inhibit its interaction with the IL-17 receptor. Both are dosed every four weeks in the maintenance phase and are available in an autoinjector.

Shane Berken, Pharm.D.

Historically, there has been some hesitancy to switch these medications on the formulary despite the growing competition in the area; there is a gap in the literature, said Shane Berken, Pharm.D., utilization management and compliance at Group Health Cooperative of South Central Wisconsin and lead investigator.

“This is historically a difficult-to-treat population and there is a high rate of obesity. We wanted to show that the switch could be done successfully,” he said recently in an interview.

Although this was a small, proof-of-concept study, Berken said the results can be applied to patients in larger groups. “This population has a very high rate of obesity, which is historically more difficult to treat with targeted immunomodulators. Most of our members who switched had actually failed at least, in some cases, three or even four biologic therapies before they before they started on Cosentyx.”

For this study, investigators measured clinical outcomes only for patients with psoriasis who switched to Taltz because of prescriber logistics and the practicality of obtaining the measurements in clinics.

Financial outcomes were reported using net cost analysis and measured for the entire population affected by the change through September 30, 2021. The entire population includes members taking Taltz before the index date of October 1, 2019, patients who were switched from Cosentyx, and members who started Taltz after October 1, 2019.

In all, 51 members were impacted by the formulary change, with a savings of $801,822. For the 11 members with psoriasis who switched, the savings $190,672.

On the clinical assessment, Berken said COVID-19 impacted the ability to some measures for outcomes with patients with psoriasis who switched to Taltz, specifically The Dermatology Life Quality Index (DLQI), body surface area (BSA), and physician global assessment (PGA), which are all recommended by the American Academy of Dermatology.

“COVID-19 did disrupt quite a few of our objective measures,” he said. “But looking at the big picture, it was directionally positive. We did have some members who had injection site reactions to Taltz, which I did expect based on it being a humanized monoclonal antibody, rather than a fully human one like as Cosentyx. But that doesn’t diminish the results.”