Prime Therapeutics’ Biosimilar Program Cut Expenses by 26%

Prime Therapeutics’ program MedDrive has achieved savings for clients in its first year, with biosimilars for treating cancer leading the way. Three biosimilar recommendations —bevacizumab, trastuzumab, and rituximab — have reduced per member per month (PMPM) costs by 26% over the past year.

The MedDrive program, originally launched in May 2021, uses advanced analytics to help health plans uncover opportunities to reduce current drug spend. MedDrive aims to realize savings by improving manufacturer contracts and recommending the use of biosimilars and other low-cost alternatives to expensive brand-name specialty drugs.

Kelly McGrail-Pokuta

“Biosimilars, while originally slow to adoption, are gaining a lot of traction in the U.S. and are proven to be helpful in reducing costs for patients who require specialty drugs, like those fighting cancer,” Kelly McGrail-Pokuta, vice president of trade relations and strategy and chief trade relations officer at Prime, said in a press release. “Within the MedDrive program, just three biosimilar categories that we’ve recommended to our clients have helped cut total drug expenses by 26% over the past year, with more savings anticipated in the next year.”

In 2021, bevacizumab cost Prime’s clients $1.05 per member per month; these drug costs were incurred on the medical side. It is used to treat several cancers, including advanced colon, advanced lung, kidney, and brain.

Genentech’s Avastin, as a reference drug for bevacizumab, has two biosimilars: Amgen’s Mvasi, launched in 2019, and Pfizer’s Zirabev, launched in 2020. The introduction of biosimilars provided some price relief. Bevacizumab has been growing at a rate of 4.87 since 2018.

Avastin has annual wholesale acquisition cost (WAC) of about $144,000; the annual WAC for the two biosimilars is 25% less.

The use of Genentech’ Herceptin (trastuzumab) among Prime’s members has been shrinking at a 5.46% rate since 2018. Its cost per member per month basis is $1.10.Every month, about 7% to 10% of its users are new starts. It is used to treat HER2+ early and late-stage breast cancer, as well as HER+ metastatic stomach cancer.

Herceptin has several biosimilars, including Agmen/Allergan’s Kanjinti, Mylan/Biocon’s Ogivri, Pfizer’s Trazimera, Celltrion/Teva’s Herzuma, and Samsung Bioepis’ Ontruzant.

While the first Herceptin biosimilar was launched in 2019, traction in the marketplace was slow until it was joined by other trastuzumab biosimilars in 2019 and 2020. In 2020, about half of Prime’s Blue Plan clients were treating the reference drug and biosimilars at parity. The other half had some form of preferred biosimilar strategy. One Prime Blue Plan client implemented a utilization management policy requiring a trial of Trazimera before use of the reference product or other nonpreferred trastuzumab agents. Within six months, the client achieved a biosimilar market share of greater than 95% and saw $0.18 per member per month in savings.

As they have come out, the prices of trastuzumab biosimilars have been 10% to 22% lower than the reference drug.

In 2020, Prime clients a mix of strategies to manage Genentech’s Rituxan (rituximab). About half of the plans treated the reference drug and biosimilars the same. The other half made the reference drug nonpreferred and gave one or both biosimilars preferred status. Overall, the movement to biosimilars has been slow.

Rituxan is approved to treat non-Hodgkin lymphoma, lymphocytic leukemia, rheumatoid arthritis, and several rare diseases, including Wegener’s granulomatosis and microscopic polyangiitis (two disorders that cause blood vessel inflammation) and Waldenstrom’s macroglobulinemia (a type of non-Hodgkin lymphoma).

The Rituxan’s annual wholesale acquisition cost is more than $60,000, depending on the diagnosis and dosage,

When the biosimilar Truxima was launched in 2019, it was priced only 10% lower than the reference drug. When the biosimilars Pfizer’s Ruxience and Amgen’s Riabni were launched in 2020 and 2021, their price 24% less than the reference drug.

One of Prime’s Blue Plan clients required use of Ruxience before other rituximab drugs. In six months, the client achieved total biosimilar market share greater than 81% and saw $0.24 per member per month in savings.