Biosimilar use alone won’t cut drug costs

By Kelly McGrail-Pokuta, Vice President of Trade Relations and Strategy, Chief Trade Relations Officer

May 23, 2022

We see it time after time. High-potential innovation that just doesn’t seem to take off like expected: self-driving cars. 3D TVs. And in recent years, many of us in the pharmaceutical space have wondered if biosimilars would be in that category.

Biosimilars are biologic products proven to have a highly similar effect to Food and Drug Administration (FDA) approved products but without the additional cost that comes with a reference brand drug. They have the potential to help address one of today’s health care crises: rising drug costs.

At Prime Therapeutics (Prime), we see a great deal of opportunity to obtain market-leading savings for clients that begin to adopt biosimilars and lower net cost options rather than high-cost reference brand biologics, which can in turn help hold down premium costs for members.

And in the last year, we’re starting to see biosimilar use substantially increase in the oncology and auto-immune categories.

So, one would think drug costs will immediately fall, right?

Unfortunately, it’s not so simple. Managing both pharmacy and medical drug spend is a challenge for most in the industry due to a lack of integration.

That’s what the Prime team set out to address with the introduction of MedDrive™, a program launched in 2021 that uses advanced analytics to help health plans uncover opportunities to reduce current drug spend. Already, three MedDrive biosimilar recommendations — bevacizumab, trastuzumab, and rituximab— have reduced per member per month (PMPM) costs by 26% over the past year.

In addition to the pharmacy and medical drug claims data available to Prime, MedDrive includes other market-leading cost-saving strategies supported by analytics and reporting, such as medical policies and clinical tools, consultative services to navigate the growing specialty landscape, provider and member education and support and more.

MedDrive helps solidify the role that Prime can play in a patient’s care team, supporting both patients and health care providers in selecting clinically appropriate and cost-effective drugs for preferred coverage.

This partnership is at the heart of opportunities for MedDrive’s growth in the future. We’re uniquely positioned to help health plans leverage and align to biosimilars and other cost-effective treatments, which helps fulfill our mission to deliver fully transparent total drug management solutions. We’re on the leading edge of this work, bringing key parts of the health care industry together – including providers, specialty pharmacies and manufacturers – to help ensure biosimilars are accepted and used as equally safe and effective treatments so people can benefit from the most appropriate drug at the lowest net cost available.

Prime’s clients have realized significant cost savings through alignment with our medical drug management strategies. And Prime’s recently announced acquisition of Magellan Rx will help us build on a next-generation integrated specialty management model post-closing, one that lowers costs and keeps the member at the center of all we do.

Alone, biosimilars won’t be a silver bullet to help drive cost savings for health plans and reduced premiums for members. But with the support of Prime’s clients and integrated, predictive analytics, I look forward to seeing what we can do together.

 

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