From conference sessions to poster presentations, biosimilars were a prominent topic of discussion at AMCP 2023. Professionals across the spectrum of managed care discussed how biosimilars' arrival to the market could impact drug costs and formulary considerations.

In this interview with First Report Managed Care, Courtney Quinn, PharmD, provides insight into how biosimilar conversion in the insulin space has the potential to impact costs for both patients and the health plans that cover them.

Can you provide an overview of your research? What was your study’s design, and who participated in it?

The goal of my research project was to investigate the potential cost savings associated with interchangeable biosimilars, particularly in the insulin space. Semglee (insulin glargine-yfgn) was the first interchangeable biosimilar for the reference product Lantus (insulin glargine) that became available on the market. Navitus made a formulary change to prefer Semglee over Lantus because Semglee had the lowest net cost for plan sponsors and health plans. This project was proposed as a way to analyze the success of that formulary change, as well as quantify any potential savings that came from coverage of an interchangeable biosimilar.

This project was a retrospective claims analysis where we analyzed members of 4 large commercial health plans who had at least 1 claim for Lantus from July 1, 2021, to December 31, 2021 (preintervention), and at least 1 claim for any long-acting insulin on the formulary from January 1, 2022, to June 30, 2022 (postintervention).

Since most states do not require prescriber intervention to switch from a reference product to an interchangeable biosimilar, patients generally did not need to wait for a new prescription, so the transition was very successful. Approximately 80% of patients in my study population who were previously using Lantus switched to either Semglee or the unbranded version of it, which we were excited to see. We had successful conversion of patients to a biosimilar product that had introduced price competition to the market and was preferred on a cost basis. 

For the cost savings analysis, we matched members from pre- to postintervention and calculated the average savings overall, or the mean decrease in total cost and net cost. Total cost was determined using sticker price and the net cost included rebates as well. We saw significant savings for clients. Total cost savings ranged from 28% to 54% depending on the plan. Regarding net cost, we found approximately 28% to 48% overall savings. 

We were really happy to see these numbers. We always want to save money for clients and members, especially in the insulin space. There have been a lot of recent changes in the insulin space, but when this project first began, the market was still very cost-prohibitive for patients, plan sponsors, and health plans. We were excited this project was successful and had a statistically significant impact on spending when compared on a member-by-member basis pre- and postintervention. 

Do you intend to do more work with insulin biosimilars in the future?

With the recent announcements of price changes in the insulin space, the landscape continues to evolve. As a company, we are definitely paying attention. We want to provide the lowest cost option and improve access and affordability both for both members and plans. Navitus will continue to monitor and assess savings incremental opportunities as additional biosimilars are expected mid-year.

Is there anything else you would like to add?

Navitus is committed to achieving the lowest net cost for clients. Our 100% pass-through business model helps drive this, as all manufacturer rebates and discounts are passed on to clients. The decision to prefer the biosimilar on formulary was based on a cost analysis to identify the lowest-net-cost option rather than on rebate value.This approach lowers the upfront cost for plan sponsors, as opposed to spending more now and awaiting a rebate several months later.

There are several other interchangeable biosimilars launching now and in the near future, and there is limited information on their impact on costs for prescription plans. This project helped compile data to show interchangeable biosimilars can be a powerful cost-saving option. As an advocate for more affordable medications for the people who need them, Navitus is focused on future opportunities to prefer lower-cost, clinically appropriate interchangeable biosimilars.

About Dr Quinn

Courtney Quinn, PharmD, is first-year PGY1 resident at Navitus Health Solutions, which is based out of Wisconsin. She graduated from University of Wisconsin-Madison Pharmacy School.