Kaiser Permanente has a 95% formulary compliance rate, and this allows the health plan to negotiate with pharmaceutical companies for lower prices.
Kaiser Permanente has switched almost 90% of its commercial and Medicare members from AbbVie’s Humira (adalimumab) to Amgen’s biosimilar Amjevita (adalimumab-atto). The health plan is taking advantage of Amjevita’s price that is 55% less than Humira, and expects to see savings of $300 million in 2023.
Humira is blockbuster drug that generated 2022 sales of more than $18.6 billion in the United States. It is used to treat several immune conditions, including rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, ulcerative colitis, Crohn’s disease, uveitis, and hidradenitis suppurative. It has a wholesale acquisition cost of $6,922 for a four-week supply.
Kaiser Permanente is one of the nation’s largest not-for-profit health plans, serving 12.7 million members in California, Colorado, Georgia, Hawaii, Washington, and Oregon, as well as the in Washington, D.C., area.
In a recent blog post, Kaiser Permanente executives talk about the plan’s commitment to biosimilar adoption and how biosimilars play an important role in improving affordability. This year, in addition to Amjevita, the health plan has begun plans to adopt Semglee (insulin glargine), the first interchangeable biosimilar product to Lantus.
Last year, Kaiser Permanente adopted two biosimilars: the cancer support therapy Nivestym (reference product Neupogen) and Riabni (reference product Rituxan), which treats rheumatoid arthritis and chronic lymphocytic leukemia.
The biosimilar strategy is paying off. In 2019 alone, Kaiser Permanente achieved savings of $140 million by switching to several biosimilars. These include the anticancer drugs Mvasi (reference product Avastin) and Kanjinti (reference product Herceptin), as well as Truxima (reference product Rituxan), which treats rheumatoid arthritis and non-Hodgkin lymphoma.
Officials attribute their success with biosimilars to several factors, including a commitment to providing physicians with unbiased data, decision making that is not influenced by drug reimbursement, and close partnerships between physicians and patients.
“In Kaiser Permanente’s highly integrated system, we advance biosimilar adoption through evidence-based formulary review, peer-to-peer physician education, and nurse and pharmacist training,” Mary Beth Lang, senior vice president and chief pharmacy officer, told Formulary Watch. “Physicians confer with pharmacists to decide biosimilar usage together.”
Lang said Kaiser Permanente conducts its own studies to ensure that a biosimilar provides similar quality and safe. “This creates confidence and commitment for doctors, our staff, and ultimately our patients. Because our prescribers trust the process, we have 95% formulary compliance,” she said.
Kaiser Permanente is able to leverage its formulary adherence and purchasing power to negotiate directly with drug manufacturers for the lowest possible price, reducing costs for Kaiser Permanente and patients. “Our system supports day-to-day clinician decision making that is not influenced by drug reimbursement or direct-to-clinician marketing by pharmaceutical sales representatives, facilitating financially neutral prescribing based on available evidence.”