Regence Health Plans Save by Switching to Infliximab Biosimilars

Regence Health Plans has achieved a more than 90% adoption of infliximab biosimilars and an associated savings of $0.42 per member per month for 2022, finds a review by Prime Therapeutics and presented at the Academy of Managed Care Pharmacy (AMCP) Nexus meeting Oct. 11 to Oct. 14, 2022.

The FDA has approved four biosimilars of the immunosuppressive drug Janssen’s Remicade (infliximab), but only three are available. It is indicated to treat patients with Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriatic arthritis and plaque psoriasis. (See table below.)

Patrick Gleason, Pharm.D.

“Understanding factors associated with high-cost drug therapy use, real-world specialty drug cost-effectiveness, biosimilar conversion programs successfulness, and likelihood members with a specialty condition will remain enrolled all contribute to the development of appropriate member programs and help clients manage costs for themselves and their employer groups,” Patrick Gleason, Pharm.D., assistant vice president for health outcomes at Prime, said in a press release.

Beginning Jan. 1, 2022, Regence, a Blue Cross plan operating in Oregon, Washington, Idaho and Utah, implemented a preferred infliximab biosimilar strategy. The strategy included not only communication to patients and providers but also to internal groups including customer service, network management, prior authorization review and appeals teams.

Regence was guided by Prime’s MedDrive program, an integrated drug management solution launched last year that leverages biosimilars to help reduce drug spend. It 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.

Related: Prime Therapeutics’ Biosimilar Program Cut Expenses by 26%

For Regence’s infliximab program, Prime researchers analyzed medical benefit drug claims from January 2021 through March 2022 for the plan’s 1.6 million commercially insured members. As a comparison, they assessed claims from January 2021 through December 2021. Prime identified actual total net cost across infliximab products in the first quarter of this and compared that against what the total net cost would have been if no preferred product change was made.

“Numerous communication channels to members and providers, a clinically appropriate and thoughtful medical policy, and a prior authorization management plan were critical to the process and to achieving early results,” researchers wrote.

One limitation, Prime researchers said, was the short timeframe of the analysis.