In the first step, the drugs with the highest annual drug spend were identified. From that group, biologicals with US Food and Drug Administration (FDA)-approved biosimilars were selected for UM initiatives. Next, an expedited formulary review process was developed that bundled multiple biosimilars for the same reference biological. This process allowed biosimilars to be added to the formulary before they were commercially available. This improved review process supported the third step, which was a pharmacoeconomic impact analysis. This analysis assessed the reimbursement structure across the different healthcare settings for each biosimilar in the formulary. For example, diagnosis-related group charges determine reimbursement in the inpatient setting. However, payer preferences (with potential need for prior authorization) affect reimbursement in outpatient settings.

In the fourth step, and as a cornerstone to the initiatives, electronic health record prescribing tools were developed. These tools streamlined the selection and ordering process by guiding the healthcare provider (HCP) to the system-preferred, lowest cost biosimilar in their particular setting. As with all system-wide changes, the change management included communications in preparation for the changes and related training. Externally, the implementation was supported by notification to biosimilar distributors and manufacturers. Internally, support was provided through physician and patient education on the safety and efficacy of biosimilars, which included existing FDA tools.

In the last step, biological medication spends, biosimilar product utilization and adoption rates and combined spend (on each reference biological and its biosimilars) were monitored. Results were reported to regional and local pharmacy leaders monthly. These reports promoted support for the biosimilar programme.

In 2019 and 2020, Providence St Joseph Health implemented UM initiatives for seven reference biologicals with available biosimilars: Avastin (bevacizumab), Herceptin (trastuzumab), Neupogen (filgrastim), Neulasta (pegfilgrastim), Procrit (epoetin alfa), Remicade (infliximab) and Rituxan (rituximab). Across all seven initiatives, US$26.9 million were saved in biologicals spending by Providence St Joseph Health. Consistent with these savings, the biosimilar adoption rates by November 2020 ranged from 33%–74%. The average adoption rate was 62%, which was notably higher than the US average.

In summary, the above-described programme increased the acceptance of biosimilars, decreased the biologicals spend, simplified HCP workflow and improved overall pharmacy sustainability for a large Integrated Health Delivery Network. This approach (and similar approaches recently described in other systems [2-4]) can improve healthcare system sustainability and patient access to care, while also maintaining the quality of patient care and health outcomes.

Disclosure
This work was supported by Providence St Joseph Health.

Conflict of interest
The author of the research paper [1] reported conflict of interest, including being an employee of Providence St Joseph Health and having received honoraria from Coherus BioSciences and Mylan for speaking engagements unrelated to the current study.

Abstracted by Sophia Humphreys, Providence St Joseph Health, Renton, Washington, USA.

Editor’s comment
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Can local policies on biosimilars optimize the use of freed resources – experiences from Italy

Local policies on biosimilars: are they designed to optimize use of liberated resources?

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Related article
The US needs to learn from Europe to increasing access to biosimilars

References
1. Humphreys SZ. Real-world evidence of a successful biosimilar adoption program. Future Oncol. 2022;18(16):1977-2006.
2. Lam SW, Amoline K, Marcum C, et al. Healthcare system conversion to a biosimilar: trials and tribulations. Am J Health Syst Pharm. 2021;78(23):2159-63.
3. Kar I, Kronz M, Kolychev E, et al. Biosimilar strategic implementation at a large health system. Am J Health Syst Pharm. 2022;79(4):268-75.
4. Bhardwaja B, Klocke S, Ekinci E, et al. Switching from biologic to biosimilar products: insight from an integrated health care system. BioDrugs. 2022;36(1):1-11.

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