Real-World Evidence of a Successful Biosimilar Adoption Program

Biosimilars have introduced new opportunities to reduce the disproportionately high US healthcare spending on biologic medications. This article describes strategic utilization management program initiatives designed to promote biosimilar utilization, reduce biologic drug costs and increase sustainability in a US nonprofit health system. Key components of these biosimilar utilization management program initiatives included expedited procedures to evaluate and establish the formulary status of biosimilars, enhanced contracting negotiations, specially designed electronic medical record tools to guide physician prescribing, payer coverage analysis, evaluations of biologic-utilization trends and financial performance analysis. Within 2 years (2019–2020), this program has resulted in savings of USD$26.9 million for Providence St Joseph Health and biosimilar adoption rates that greatly exceed the US national average.