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Pharmacy savings with biosimilars

December 14, 2021

Specialty drug spend continues to drive our members’ rising total cost of care. In the August 2021 edition of Producer News, we covered several innovative, cost-saving solutions to address pharmacy costs. Heading into 2022, we’re excited to share another way we’re taking action to ensure our members receive the pharmaceutical therapies they need at the lowest available cost: biosimilars.

Biosimilars 101

Medications derived from living organisms rather than chemical synthesis are known as biologic drugs. These pharmaceutical therapies have existed for more than 100 years. Examples of biologic drugs include vaccines and insulin.

Biologic drugs are used to diagnose, prevent, treat and cure many diseases and medical conditions, including certain types of cancer. Once the patent for a biologic product expires, manufacturers are free to create what are known as biosimilars.

To be approved by the U.S. Food and Drug Administration (FDA), there must be no clinically meaningful differences—both in safety and effectiveness—between a biosimilar drug and the existing biologic product, which is sometimes called the “reference product.” Biosimilar drugs are expected to produce the same clinical result as the reference product.

According to the FDA, all approved biological products, including biosimilar drugs and their reference products, undergo a rigorous evaluation so patients and providers can be assured of a biosimilar’s efficacy, safety and quality.

Biosimilars deliver quality care with significant cost savings

Many FDA-approved biosimilars have entered the market, and they typically have initial prices that are 15% to 35% below the reference products’ costs. In some cases the savings are even greater. According to the RAND Corporation, biosimilars could save the U.S. health system an estimated $54 billion in the next ten years.

In July 2020, we moved the biologic drugs Rituxan, Herceptin and Avastin to non-preferred status to move market share to the preferred, biosimilar versions. Since then, shifting our members to biosimilars has saved more than $15 million—significant savings that will benefit the health plan, our members and groups without sacrificing care quality.

On those rare occasions when a Regence member doesn’t tolerate a biosimilar, their doctor may request pre-authorization for a different biosimilar or the reference product.

Biosimilar savings in 2022: Inflectra and Semglee (or unbranded version)

Effective Jan. 1, 2022, Regence is changing the formulary status for two medications to continue driving utilization of high-quality, cost-effective biosimilars:

Remicade, the brand-name drug for infliximab, treats rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, and other autoimmune conditions. All infliximab products require pre-authorization (PA), including the preferred biosimilar Inflectra.

Lantus and Lantus Solostar, the brand-name drugs for insulin glargine, treat diabetes. The preferred biosimilar Semglee (also known as insulin glargine-yfgn) doesn’t require PA, while the non-preferred biosimilar Basaglar does. Continued coverage of Lantus will also require pre-authorization. Semglee and its unbranded equivalent are the first biosimilars to be granted interchangeable status with a brand-name equivalent—Lantus—by the FDA. This means they may be substituted at a pharmacy without a different prescription, similar to how generic drugs are routinely substituted for brand-name drugs.

We’ve communicated these formulary PA and biosimilar changes to our members, prescribing providers and network pharmacies. Our Customer Service and Pharmacy teams are prepared to support impacted members to ensure they receive the high-quality care they need at the best possible price.

Working together to drive Rx care quality and cost containment

Biosimilars will continue to be part of our overall strategy for ensuring our members have access to the safest, most cost-effective and highest-quality medications available. In 2022 we look forward to building on our formulary enhancements, innovative programs and other efforts to address rising pharmacy costs. This includes exploring both broad and targeted solutions for specialty drugs while monitoring pharmaceutical products coming to market.

Questions? Please contact your account representative. You can also explore other recent Rx content: