Better together: Health Alliance and Carle Health using biosimilar therapies to help make care more accessible and affordable

“We are always looking for ways to lower drug costs while maintaining the best medical outcomes for our members,” Brian Smolich vice president of Health Alliance™ Pharmacy and Medical UM and Systems, says. That is why in early 2023, when several biopharmaceutical companies launched biosimilars for adalimumab as a substitute for Humira®, Smolich and others saw it as a potential game-changer for many patients diagnosed with certain types of arthritis and other inflammation-related diseases.

“Humira was the number one drug by cost that our members used to manage their chronic health conditions,” Smolich explains. “On average, we were seeing an annual cost for the drug approaching $100,000 per member. When the FDA approved the biosimilar option, it was a beacon of hope. It’s a win for patients, providers and insurers, offering an optimistic outlook for the future of healthcare.”

Biosimilars are nearly identical versions of FDA-approved biologics – meaning they have no clinically meaningful differences from the previously approved originator biologic drug. Similar to a generic drug, biosimilars can provide a lower-cost version of a brand-name drug.

“Because some biologics like Humira fall into a very expensive drug class, they can have a direct impact on a person’s ability to afford the cost of care, which is concerning,” Michael Smith, MD, chief medical officer of Health Alliance, shares. “Fortunately, due to our strong collaboration and vertical integration with Carle Health, we are able to see a complete picture of an individual’s situation and act on options, like biosimilars, that enable greater patient access to highly specialized treatments and are more affordable to everyone. This comprehensive approach gives us hope for a more accessible and sustainable healthcare future.”

Last year, Health Alliance made significant strides in the use of biosimilar therapies for autoimmune disorders like rheumatoid arthritis, psoriasis and GI disorders. Provider engagement, education and support led to increased communication with patients and members about biosimilars and the safety and efficacy of these options. By year’s end, Carle providers successfully transitioned patients to biosimilar options in 60% of their prescriptions without impacting patient care, a testament to the safety and efficacy of these treatments. This change provides substantial value to members by lowering pharmacy expenditures and helping to control the rising cost of care.

“We anticipate being able to offer more biosimilar treatment options within the parameters of treatment recommendations as patents for additional biological drugs reach the end of their market exclusivity period,” Smolich shares. “We are in a good position. We are hearing that the uptake of these new products has been slow across the industry but are happy to see that Carle Health has done a great job in our Vision of providing highly accessible, world-class care and service.”

Whether providing healthcare to patients or helping members with care coordination, the goal of every interaction centers on service excellence. “We are working together to lower the cost of care for members and patients without sacrificing the quality of care or the success of treatments,” Dr. Smith says. “It’s an informed conversation each of us is having with those who may be eligible now or in the future for biosimilar treatment options. It’s an opportunity to positively impact more of the people who place their trust in Health Alliance and Carle Health.”