System-wide approach on biosimilars adoption in oncology: Strategic plan on switching and cost savings

1600 Background: Biosimilars provide competitive, lower-cost alternatives to biologic drugs in cancer treatment. As more agents become available in the US, institutions have to implement a strategy for successful adoption that is feasible, safe and provide price competition among biosimilar manufacturers. Methods: We aimed to standardize biosimilar utilization across the Cedars-Sinai Health System (CSHS) by integrating institutionally developed clinical pathways and insurance prior-authorization into the existing electronic health record (EHR). The initial study was limited to bevacizumab, rituximab and trastuzumab. To align with CSHS guideline recommendations, biosimilar indications for use were reviewed by each disease related group (DRG). Biosimilar brands for each drug were selected through a formulary process vetted by the Pharmacy & Therapeutics Committee. Physicians were permitted to opt-out of switching via an option provided within the electronic order set. To test feasibility of this approach, patients were divided into two groups as 1) main medical center (Cedars Sinai Medical Center) and 2) Cedars-Sinai Cancer affiliated sites. Feasibility was defined as a compliance rate of 80% or greater at the main medical center and 75% or greater at the affiliated sites. This study was powered to detect a minimum difference at 5.7% and 8.9%, respectively. Results: Between January 2021 to September 2022, a total of 1,139 cancer patients who initiated treatment with bevacizumab, rituximab or trastuzumab were identified through the EHR, of whom 650 were eligible (age 18-96; 61% female, 39% male). Using our approach, the compliance rate was 86% at the main site (p<0.001, 95%CI: 82.5-89.1) and 88% (p<0.001, 95%CI: 82.1-91.7) at the affiliated sites, resulting in a 56% improvement from baseline (86% vs. 55%, p<0.001). Among 14% of patients who did not switch to institutional-preferred biosimilar brands, the most common reasons for this were payer mandated use of an alternate brand (5%), off-label indication (4%), enrolled in patient assistance program (3%) and physician preference (2%). Five patients (<1%) did not switch to biosimilars due to history of infusion reactions. Insurance type (HMO, PPO, Medicare, others) was not associated with non-compliance (p=0.876). Cost savings were projected to be over $4 million over a duration of two years. Conclusions: Enterprise-wide switching to one specific biosimilar brand is feasible and facilitated through leveraging of the EHR. This approach optimized exiting organizational infrastructure to standardize biosimilar utilization and promote substantial cost savings.[Table: see text]