Magellan Rx Management Biosimilar Program Shifts Infliximab Utilization by 86% in First Year, Resulting in 34% Drug Cost Savi...
April 16 2019 - 6:30AM
Business Wire
Magellan Rx Management, the pharmacy benefit management (PBM)
division of Magellan Health, Inc. (NASDAQ: MGLN), released new data
today showcasing results from its medical pharmacy program focused
on biosimilar management. The results revealed that health plan
organizations saw a significant shift in utilization from high-cost
drugs to lower-cost biosimilar formulations after implementation of
a medical benefit drug management solution, yielding substantial
drug cost savings while maintaining a high level of clinical
quality.
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Health plan infliximab market share
(Graphic: Business Wire)
Producing Real Savings with a Forward-Thinking
Approach
The program leverages a comprehensive utilization management
(UM) solution to shift utilization to the lower-cost biosimilar
versions of infliximab, which is used to treat autoimmune
conditions such as rheumatoid arthritis and inflammatory bowel
disease. In support of this initiative, a team of highly-trained
pharmacists developed a robust clinical policy, working with
physician offices and hospitals to ensure appropriate utilization
for each patient’s unique situation. Though not considered directly
interchangeable with their innovator brand counterparts,
biosimilars are regarded as providing the same levels of clinical
efficacy and safety, while offering the added benefit of potential
cost-savings to payers and patients alike.
“These are difficult-to-manage therapies,” said Steve Cutts,
senior vice president and general manager, specialty. “But with
over 16 years of targeted, total specialty drug management
expertise, Magellan Rx—and our health plan customers—are in a prime
position to embrace biosimilar availability of these high-cost
drugs and produce real savings for all involved, not only through
our clinically-sound utilization management program but also by
negotiating enhanced discounts for the biosimilar versions.”
- Health plan customers implementing a
comprehensive management approach that transitions all patients to
a biosimilar agent have reported a shift in market share of up to
86 percent.
- Even when utilizing a softer approach
that mandates only new patients use the biosimilar version, health
plans have experienced an uptake in biosimilar utilization as high
as 75 percent.
According to the latest edition of the Magellan Rx Management
Medical Pharmacy Trend ReportTM, Remicade, the brand name for
infliximab, is the highest-spend drug on the medical benefit.1
Although biosimilar competition for infliximab has existed since
2016 in the United States, health plans have continued to see an
increase in infliximab spend, including a 14 percent increase in
Remicade per-member-per-month (PMPM) for commercial health plans
from 2016 to 2017.1 It’s reported that payers spend $43,000 per
patient annually1 on the reference brand, yet the ingredient cost
of biosimilars can be up to 35 percent less.2 Furthermore, medical
pharmacy management strategies coupled with benefit design changes
can have meaningful impact on lowering patient out-of-pocket
costs.
“Leveraging our expertise in this field, we help our customers
take advantage of leading-edge, thoughtful formulary management and
clinical programs that can drive true drug cost savings,” said
Cutts. “We look forward to building upon our early successes here,
and continuing to roll up our sleeves and solve complex specialty
pharmacy challenges.”
For more on the latest in medical pharmacy trends and biosimilar
management strategies, download the ninth edition of the Magellan
Rx Management Medical Pharmacy Trend Report.
1. 2018 Magellan Rx
Management Medical Pharmacy Trend ReportTM, ©2019. 2.
van de Vooren, K., Curto, A. &
Garattini, L. Appl Health Econ Health Policy (2015) 13: 125.
https://doi.org/10.1007/s40258-015-0154-9
About Magellan Rx Management: Magellan Rx Management, a
division of Magellan Health, Inc., is a full-service,
next-generation pharmacy benefit manager (PBM) that helps our
customers and members solve complex pharmacy challenges by
connecting them to the people, technology, and information they
need to make smarter healthcare decisions. As experts in managing
specialty spend both on the prescription and medical benefit, we
are energized by discovering new and better ways to deliver
solutions in today’s complex and rapidly-evolving healthcare
environment, leading people to live healthier, more vibrant
lives.
About Magellan Health: Magellan Health, Inc., a Fortune
500 company, is a leader in managing the fastest growing, most
complex areas of health, including special populations, complete
pharmacy benefits and other specialty areas of healthcare. Magellan
supports innovative ways of accessing better health through
technology, while remaining focused on the critical personal
relationships that are necessary to achieve a healthy, vibrant
life. Magellan's customers include health plans and other managed
care organizations, employers, labor unions, various military and
governmental agencies and third-party administrators. For more
information, visit MagellanHealth.com.
(MGLN-GEN)
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version on businesswire.com: https://www.businesswire.com/news/home/20190416005326/en/
Media Contact: Lilly Ackley, ackleyl@magellanhealth.com,
(860) 507-1923
Investor Contact: Joe Bogdan, jbogdan@magellanhealth.com,
(860) 507-1910
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