Brand-to-brand nonmedical switching among interleukin-17 inhibitors or other biologics: Implications of a formulary change.

IF 2.3 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of managed care & specialty pharmacy Pub Date : 2025-06-01 Epub Date: 2025-04-23 DOI:10.18553/jmcp.2025.24317

A Mark Fendrick, Manish Mittal, Yi Peng, Beverly Johns, Cynthia Holmes, Yifei Liu

{"title":"Brand-to-brand nonmedical switching among interleukin-17 inhibitors or other biologics: Implications of a formulary change.","authors":"A Mark Fendrick, Manish Mittal, Yi Peng, Beverly Johns, Cynthia Holmes, Yifei Liu","doi":"10.18553/jmcp.2025.24317","DOIUrl":null,"url":null,"abstract":"Background: In 2021, a large pharmacy benefit management organization (PBM) changed preferred agents on its national formulary from one branded interleukin (IL)-17 inhibitor (TxA) to another (TxB), prompting a nonmedical switch (NMS) for patients using TxA.Objective: To evaluate the impact of this formulary change on treatment patterns among patients with psoriasis, psoriatic arthritis, or ankylosing spondylitis.Methods: Patients receiving TxA for at least 84 days and no other biologic from July 2020 to December 2020 were identified using PBM-specific data from the Symphony Health Analytics database. Two comparator groups were established: patients affected (PBM-1) and not affected (PBM-2) by the formulary change. Outcomes were (1) changes in monthly fills of TxA/TxB (July 2020 to June 2021; PBM-1 group only), (2) proportion of TxA-treated patients experiencing any medication discontinuation or switching (PBM-1 and PBM-2 groups), and (3) medication-taking behaviors (adherence, discontinuation, switching) among patients continuing TxA vs those that NMS to TxB (PBM-1 group only).Results: Demographics were similar for patients in PBM-1 (N = 1,703) and PBM-2 (N = 462). After the formulary change (January 2021 to June 2021), TxA prescription fills decreased 7% while TxB fills increased 8% in the PBM-1 group. Compared with patients not affected by the formulary change (PBM-2 group), significantly more patients in the PBM-1 group completely discontinued treatment (27% vs 14%). The PBM-1 vs PBM-2 group had significantly higher (P < 0.001) rates of switching to TxB (19% vs 1%) or another biologic (8% vs 2%). Following NMS from TxA to TxB, patients in the PBM-1 group had significantly (P < 0.05) lower adherence rates (46% vs 63%) and higher rates of subsequent switching (14% vs 6%) or absolute discontinuation (20% vs 14%) than those continuing TxA.Conclusions: Following the formulary change, more than 25% of patients exposed to the change experienced treatment discontinuation, nearly double the rate than those not exposed. This unfavorable finding, along with higher rates of nonadherence and subsequent switching, warrants careful monitoring of similar policy changes.","PeriodicalId":16170,"journal":{"name":"Journal of managed care & specialty pharmacy","volume":" ","pages":"544-551"},"PeriodicalIF":2.3000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123194/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of managed care & specialty pharmacy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.18553/jmcp.2025.24317","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/23 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Background: In 2021, a large pharmacy benefit management organization (PBM) changed preferred agents on its national formulary from one branded interleukin (IL)-17 inhibitor (TxA) to another (TxB), prompting a nonmedical switch (NMS) for patients using TxA.

Objective: To evaluate the impact of this formulary change on treatment patterns among patients with psoriasis, psoriatic arthritis, or ankylosing spondylitis.

Methods: Patients receiving TxA for at least 84 days and no other biologic from July 2020 to December 2020 were identified using PBM-specific data from the Symphony Health Analytics database. Two comparator groups were established: patients affected (PBM-1) and not affected (PBM-2) by the formulary change. Outcomes were (1) changes in monthly fills of TxA/TxB (July 2020 to June 2021; PBM-1 group only), (2) proportion of TxA-treated patients experiencing any medication discontinuation or switching (PBM-1 and PBM-2 groups), and (3) medication-taking behaviors (adherence, discontinuation, switching) among patients continuing TxA vs those that NMS to TxB (PBM-1 group only).

Results: Demographics were similar for patients in PBM-1 (N = 1,703) and PBM-2 (N = 462). After the formulary change (January 2021 to June 2021), TxA prescription fills decreased 7% while TxB fills increased 8% in the PBM-1 group. Compared with patients not affected by the formulary change (PBM-2 group), significantly more patients in the PBM-1 group completely discontinued treatment (27% vs 14%). The PBM-1 vs PBM-2 group had significantly higher (P < 0.001) rates of switching to TxB (19% vs 1%) or another biologic (8% vs 2%). Following NMS from TxA to TxB, patients in the PBM-1 group had significantly (P < 0.05) lower adherence rates (46% vs 63%) and higher rates of subsequent switching (14% vs 6%) or absolute discontinuation (20% vs 14%) than those continuing TxA.

Conclusions: Following the formulary change, more than 25% of patients exposed to the change experienced treatment discontinuation, nearly double the rate than those not exposed. This unfavorable finding, along with higher rates of nonadherence and subsequent switching, warrants careful monitoring of similar policy changes.

查看原文本刊更多论文

在白细胞介素-17抑制剂或其他生物制剂之间的品牌到品牌的非医疗转换：处方变化的含义。

背景：2021年，一家大型药品福利管理组织（PBM）将其国家处方中的首选药物从一种品牌的白介素(IL)-17抑制剂（TxA）改为另一种品牌的TxB，促使使用TxA的患者进行非医疗转换（NMS）。目的：评价方剂变化对银屑病、银屑病关节炎或强直性脊柱炎患者治疗模式的影响。方法：从2020年7月至2020年12月，使用Symphony Health Analytics数据库中的pbm特异性数据确定接受TxA治疗至少84天且未使用其他生物制剂的患者。建立两个比较组：受处方变化影响的患者（PBM-1）和未受PBM-2影响的患者（PBM-2）。结果：①2020年7月至2021年6月，TxA/TxB的月填充量变化；(2)接受TxA治疗的患者停药或切换药物的比例（PBM-1组和PBM-2组），以及(3)继续服用TxA的患者与NMS转TxB的患者（仅PBM-1组）的服药行为（依从性、停药、切换）。结果：PBM-1患者（N = 1703）和PBM-2患者（N = 462）的人口统计学相似。处方变更后（2021年1月至2021年6月），PBM-1组TxA处方填充量减少7%，TxB处方填充量增加8%。与不受处方改变影响的患者（PBM-2组）相比，PBM-1组中完全停止治疗的患者明显更多（27%对14%）。结论：改变处方后，超过25%接受改变的患者停药，几乎是未接受改变的患者停药率的两倍。这一不利的发现，以及更高的不遵守率和随后的转换，值得仔细监测类似的政策变化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of managed care & specialty pharmacy Health Professions-Pharmacy

CiteScore

3.50

自引率

4.80%

发文量

131

期刊介绍： JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.