Successful Transition to an Infliximab Biosimilar at an Academic Hospital

Abstract

Introduction: Health systems face pressure from payors (government subsidized and commercial) to reduce medical expenses. The biosimilar infliximab-dyyb (IFX-dyyb, Inflectra) presents an opportunity to bend the cost curve, with a savings of 20-30% over infliximab (IFX, Remicade). In addition, organizations such as the Crohn's and Colitis Foundation are not opposed to a one-time switch between an originator and biosimilar by third parties (www.crohnscolitisfoundation.org/resources/biosimilars.html). However, many institutions struggle to operationalize biosimilar adaptation due to a lack of consensus amongst providers, lack of interchangeability designation from the FDA, and payor incentivization on the back end with significant rebates. Methods: After a review of clinical data, discussions with all prescribing providers and formulary committee approval, Boston Medical Center (BMC) decided to replace IFX with IFX-dyyb as the preferred formulary agent for all indications. Patients who had been on IFX for at least 6 months or who were new starts to IFX after 3/5/18 were identified to recieve IFX-dyyb. Those patients who received IFX via home infusion or in multiple locations were excluded. The BMC rapid infusion protocol remained unchanged for those patients transitioning to IFX-dyyb. Results: By end of May 2018, 124 patients were identified to receive IFX-dyyb. Patients receving infusions at home (n=1) or in multiple locations (n=4) were excluded. Payors, primarily Harvard Pilgrim Health Care, denied IFX-dyyb for 13 patients as it was not deemed medically necessary. Only 3 patients declined the switch to IFX-dyyb, but 1 was later excluded due to change in infusion location. A total of 108 patients are now receiving IFX-dyyb (8 new starts and 100 transitions). This represents a conversion rate of 98% (108/110 patients) excluding payor denials. Pharmacists spent an average of 5-10 minutes on the phone per patient providing education and answering questions. Conclusion: The transition from IFX to IFX-dyyb represents a reduction in health care costs to BMC. However, it is important to note that contracts between payors and pharmaceutical companies working against the biosimilar adoption leave health systems with the cost. Operationally, we felt that the educational telephone outreach to patients helped facilitate the adaptation of the biosimilar IFX-dyyb at our institution. The high patient conversion rate achieved at BMC shows that transition to a biosimilar is feasible with a team approach.1141 Figure 1. Flow chart detailing patient selection and tasks undertaken by the pharmacy team to inform patients of the switch to IFX-dyyb.