In the case reviewed, the pharmacy department created an interdisciplinary Biosimilar Task Force responsible for making decisions relating to the adoption of biosimilar therapies.
In a case study presented at the American Society of Health-System Pharmacists’ Midyear 2021 conference, pharmacists implemented a reliable process for evaluating the financial impact of biosimilar drug options. According to the investigators, this analysis assists with selecting the optimal system formulary biologic agents where biosimilar options exist. Further, the process allows for future reevaluation to ensure that the decisions made remain appropriate.
In the case reviewed, the pharmacy department created an interdisciplinary Biosimilar Task Force responsible for making decisions relating to the adoption of biosimilar therapies, with a subgroup called the Pharmacy Biosimilar Workgroup. Workgroup members included pharmacy business managers, clinical pharmacy managers, pharmacy specialists, payment model analysts, pharmacy analysts, and data support analysts. Medication costs were researched based on multiple factors, including the 340B status of each system hospital.
According to the workgroup, the best way to analyze and present options for biosimilar adoption to leaders on the task force was to evaluate the net margin of each biologic agent. Net margin is influenced by multiple factors, including ongoing price negotiation with manufacturers, reimbursement negotiation with commercial payers, covered entity 340B status, CMS’ average sales price, and CMS’ pass-through status.
For each payer, net margin should be calculated separately and then summed in order to find the overall net margin; each agent is then compared to the current biologic on the formulary. This information is then used to develop functioning cost analysis tools and standard presentation templates in order to support the decision-making process of the task force.
Based on the results, the processes developed to obtain and validate health-system financial utilization data were ultimately found to be effective. Retrospective analysis of biologic agent utilization was then used to project biosimilar utilization in the future.
The task force developed processes to collect up-to-date drug cost, payer mix, and payer reimbursement information, and tools were created to analyze each drug’s net margin based on drug cost and reimbursement.
The Biosimilar Task Force has been able to utilize the data processed by the Pharmacy Biosimilar Workgroup to make effective decisions on whether to adopt new biosimilar agents and when. These efforts have resulted in positive margins for all biosimilar agents adopted.
Walker D, Speerhas T. Implementation of a review and adoption process for biosimilar therapies at a multi-hospital health system. Presented at: ASHP Midyear 2021. Accessed December 6, 2021.