MedDrive™ derives biosimilar savings from oncology monoclonal antibodies

Experience shows that preferred status for biosimilars moves market share

November 23, 2021

MedDrive has identified cost-saving biosimilar strategies for three oncology biosimilars:

  • rituximab (Rituxan®—reference drug)
  • trastuzumab (Herceptin®—reference drug)
  • bevacizumab (Avastin®—reference drug)

All three of these drugs were developed and introduced in the United States by Genentech, Inc. They are all monoclonal antibodies or mABs. (Note that the drug names all end in “MAB.”)

Over the next four weeks, we’ll post articles that provide an overview of these drugs, how they are used, Prime’s recommendation, and the results to look for.

Once these strategies are in place, these three biosimilar strategies can deliver more than $100 million in annual savings to Prime’s Blue Plan clients.

DEFINITION: Antibodies occur naturally in the body to fight off germs and infections.
DEFINITION: Monoclonal antibodies are laboratory-developed proteins that can bind to substances in the body to help treat cancer. Monoclonal refers to a lot of copies of one type of antibody. There are many types of mABs. Each is made to bind to only one substance or antigen. mABs work by finding and blocking the growth of specific proteins on cancer cells. Some oncology mABs work on one type of cancer; others work on several types of cancer. Several new mABs are in clinical trials in the drug pipeline.1

These three reference drugs – Rituxan, Herceptin, Avastin – ranked seventh, eighth and ninth on the list of best selling prescription drugs of all time, according to NASDAQ.It can cost between $100 and $300 million and take four years to develop and bring a biosimilar to market.3 Manufacturers are likely to select big blockbuster drugs as reference drugs to ensure the best returns on their investment.

These drugs already have biosimilars on the market. Because these alternatives have been available for a few years, they have some market awareness. Now, putting in place preferred biosimilars strategies will work toward much greater savings.

Prime analyzes medical and pharmacy claims

When Prime studies drug costs, it looks at both pharmacy and medical claims. Across the book of business, 25% of drug costs go through the medical benefit. When you look at oncology, the percentage is even higher.

These drugs are used to treat several different kinds of cancers, autoimmune and orphan diseases. To understand how they are being used for one condition vs another, we want to separate those costs. Sometimes we need to look for indications in the patient’s file, like diagnosis codes and other drugs they’re taking. And we look at claims right down to the HCPCS – the health care common procedure coding system. This helps us analyze costs by condition.

All of this, and more, combines to give us the actionable intelligence for managing medical side drugs through MedDrive.

MedDrive medical solutions is a complete toolkit

MedDrive leverages the collective strength of Prime’s client membership to help control medical costs. Client savings are obtained through:

  • Improved rebates from manufacturers
  • Lower net costs with shift of use from expensive medical drugs to lower cost alternatives, such as biosimilars
  • Lower cost alternatives within the same therapeutic class

Through MedDrive, Prime’s Blue Plan clients are executing preferred biosimilar programs that are designed to save them hundreds of millions of dollars. We’ll continue to showcase these success stories in coming weeks. For more information, contact your local Prime representative.


References

  1. National Cancer Institute. NCI dictionary of cancer terms: monoclonal antibody. Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/monoclonal-antibody
  2. The 19 Best-Selling Prescription Drugs of All-Time | Nasdaq. March 13, 2017. Accessed at: https://www.nasdaq.com/articles/19-best-selling-prescription-drugs-all-time-2017-03-13
  3. Barriers to biosimilar market growth | Alvarez & Marsal | Management Consulting | Professional Services. (alvarezandmarsal.com). Accessed at: https://akamai.alvarezandmarsal.com/insights/barriers-biosimilar-market-growth#:~:text=It%20is%20estimated%20that%20it%20could%20take%20at,bring%20a%20new%20biosimilar%20to%20the%20market.%20%5Bxxii%5D%2C%5Bxxiii%5D

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