Category: Professional Posters
Purpose: To provide insight into the various challenges and advantages associated with the implementation of system pharmacy and therapeutics committee (P&T) approved therapeutic interchanges for select biosimilars infliximab-dyyb, pegfilgrastim-cbqv, and filgrastim-sndz in a community hospital within a health system that utilizes an electronic medical record (EMR).
Methods: At a community hospital within a 15 hospital health system, a site-specific strategy to increase biosimilar utilization was initiated after the system P&T approved therapeutic interchanges to the biosimilars infliximab-dyyb, pegfilgrastim-cbqv, and filgrastim-sndz, from their respective reference products. The strategy has incorporated a preferred product in the EMR for filgrastim thus far. Dispensing records from January 2018 to January 2019 were reviewed to identify the providers at the site, who prescribed these reference products. Upon analysis, an initial 50 percent conversion from the reference products to the biosimilars was targeted at the community hospital outpatient infusion center. “Dear doctor letters” were emailed to providers prior to implementing auto-substitutions to encourage prescribing of biosimilars and to streamline insurance approvals. If provider resistance was encountered, follow-up letters were sent to clarify ongoing system strategies and to provide additional supporting evidence for biosimilar usage, safety, and efficacy. Reminders were sent to providers every three months to continue open lines of communication, encourage biosimilar prescribing, and provide system updates. Once providers acknowledged receipt of the information, the financial clearance team secured prior authorization for biosimilars prior to the patients’ next scheduled doses. Pharmacists confirmed insurance approval status via an HTML based, financial clearance prior authorization transactional hub to ensure reimbursement. Conversion to biosimilars and cost savings were subsequently tracked and reported to hospital leadership on a monthly basis.
Results: Team members involved in the initiative included infusion nurses, oncology pharmacists, and financial clearance staff. All parties were in direct communication throughout the implementation timeframe of January 2019 to May 2019. Total patients targeted for conversion were as follows: 26 patients for infliximab, 17 patients for pegfilgrastim and 20 patients for filgrastim. The number of patients successfully converted to biosimilars were as follows: 10 (38.5%) of infliximab, 4 (23.5%) of pegfilgrastim, and 9 (45%) of filgrastim. Relative percent cost savings of those converted were as follows: 51.9% for infliximab, 15.7% for pegfilgrastim, and 13.3% for filgrastim. Regarding the providers involved, only one was resistant, and discussions about biosimilars continue with this provider. Two doses of reference pegfilgrastim were dispensed in place of pegfilgrastim-cbqv, and team members continue to strategize to improve financial clearance communication as a result.
Conclusion: Despite the influx of biosimilars into the mainstream market and the significant financial incentive to prescribe them, the initial transition to these products is often met with logistical challenges and provider resistance. This resistance typically stems from the perceived paucity of comparative product analyses, limited Food and Drug Administration guidance on biosimilar conversions, and insurance mandated approval of select reference products based on variable payor formularies. Overall, the community hospital implementation has yielded significant cost savings to the site and has shown successful movement toward the health system strategy.