Regence health plans are leading the nation in biosimilars utilization with 95 percent adoption, reducing specialty drug spend by $37 million annually.
Biologics are specialty drugs that represent some of the most expensive treatments in the U.S., with annual costs averaging tens of thousands of dollars per member. While specialty drugs account for less than 2 percent of Regence’s insurance claims, they are responsible for more than 55 percent of annual drug spend. Biologics are made using living organisms, which can include the cells of plants or animals. Biosimilars are biologics that are highly similar and as safe and effective as the originator biologic, while costing 15 to 30 percent less. Today, biologics and biosimilars are available to treat rheumatoid arthritis, psoriasis, Crohn’s disease, multiple sclerosis, diabetes, certain cancers, hemophilia and other conditions.
“Biosimilar adoption involves collaboration between multiple segments of the health care system, including members, providers, payers and manufacturers,” said David Robertson, Regence’s vice president of Pharmacy Services. “Accelerating biosimilar use will drive meaningful cost savings and health care sustainability, while maintaining quality of care for some of the most complex diseases members face.”
Minimizing barriers to biosimilars
Regence enabled successful member adoption by implementing a comprehensive strategy that featured robust communications campaigns, medical policies supportive of members’ unique needs and alleviating provider barriers to switching. To increase familiarity and trust in biosimilars, Regence developed educational content for members and providers highlighting their value, including safety, efficacy and cost savings. Frequent and transparent communications with members and their providers began as early as six months before a switch went into effect.
When selecting preferred biosimilars, Regence evaluated manufacturer capacity to ensure treatment availability. Pre-authorization requirements were either removed or pre-approved for preferred biosimilars to facilitate an effortless transition for members and providers. Regence also informed infusion sites in advance of the switch to ensure they increased supply of preferred biosimilars to meet the higher demand.
Breaking through conversion hesitance in chronic conditions
When treatments for chronic conditions demonstrate effective symptom management, there is often increased reluctance to switch from an originator biologic to a biosimilar. In rheumatology, infliximab biosimilars have only reached 40 percent market share despite the first biosimilar launching in 2016. By designing and implementing a thoughtful and coordinated strategy that solved for potential member and provider barriers before switching, Regence increased infliximab biosimilar adoption from 11 percent to over 94 percent in just three months.
As more biosimilars enter the market in 2023, greater competition will drive down costs while increasing access and affordability for these important treatments.
Regence serves more than 3.4 million people through its Regence health plans in Idaho, Oregon, Utah and Washington. Each Regence health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit regence.com.