The AMCP session titled "Leveraging Real-World Data to Advance Managed Care Pharmacy Practice" featured presentations from 4 recipients of the Platinum Ribbon for their top-rated poster submissions. Spanning real-world evidence and economic modeling, the presenters explored key issues impacting formulary strategy, therapeutic cost-effectiveness, and clinical utilization patterns in managed care pharmacy. This summary captures the highlights of each presentation, focusing on how data is informing clinical outcomes, cost-containment strategies, and patient access to care.

Henriette Coetzer, MD, senior vice president, chief medical officer, Blue Health Intelligence, and Sunil Swami, PhD, senior principal clinical advisor, Blue Health Intelligence kicked off the session. They discussed their retrospective cohort study on the side effects and cost implications of glucagon-like peptid-1 (GLP-1) receptor agonists, using data from the Blue Health Intelligence National Data Warehouse from 2014 through 2024. With over 1 million matched cases and 2.6 million controls, the study found a consistent rise in pharmacy utilization and gastrointestinal side effects—especially GERD, nausea, vomiting, constipation, and diarrhea—among patients who use GLP-1. Notably, the persistence of side effects and increased medication use persisted over time, even when excluding GLP-1 drug costs. These findings underscore the importance of accounting for long-term side effect management costs when considering benefit structures and formulary decisions for GLP-1 coverage.

Ruth Wangia Dixon, PhD, research scientist at Carelon Research, presented her findings on real-world usage patterns of bevacizumab biosimilars for metastatic colorectal cancer and non–small cell lung cancer between 2018 and 2023 using Carelon Research data. After biosimilars entered the market in 2019, a noticeable shift occurred—originator product usage spiked initially (likely due to manufacturer incentives), then declined as biosimilar adoption steadily increased. For colorectal cancer, the uptake of biosimilars was robust and consistent. In contrast, uptake for lung cancer was more intermittent, reflecting therapeutic changes due to the introduction of immune checkpoint inhibitors.

“Overall, the data reveals a trend that adoption of bevacizumab biosimilars consistently rose from 2019 to 2022 and then the use of the originator product declined during those during those years, and this was demonstrated by the evolving portion of patients initiating treatment with either bevacizumab originator product or their biosimilars,” said Dr Dixon. Importantly, patient demographics, adverse events, and survival outcomes were consistent between biosimilars and originators, reinforcing their clinical equivalence.

Sourab Ganna, PhamD, University of Houston College of Pharmacy, presented an economic evaluation of a new antidepressant combining dextromethorphan and bupropion, which promises faster onset (as little as 2 weeks) compared to conventional therapies. Despite its clinical advantages, including higher remission rates and lower relapse potential, the drug's high cost (~$15 000 annually) yielded an incremental cost-effectiveness ratio (ICER) of $518 000 per quality-adjusted life year (QALY)—far exceeding the $100 000 willingness-to-pay threshold. Sensitivity analyses showed that unless the cost drops significantly or remission rates improve substantially, broad formulary inclusion may not be justified. Targeted patient selection and potential price negotiations were suggested to enhance cost-effectiveness.

Stephen Quillen, PharmD, senior director, IPD Analytics, shared his study’s findings on the implications of the average manufacturer price (AMP) cap removal in 2024 on Medicaid rebates. By analyzing drugs whose list prices dropped by at least 30%—including Advair, Symbicort, Humalog, and others—he found that statutory Medicaid rebates decreased significantly post-list price reductions, shifting from over 95% of wholesale acquisition cost (WAC) in 2023 to under 60% in 2024. Despite these changes, 10 reviewed state Medicaid formularies did not alter their brand-over-generic strategies. The study concluded that lowering list prices remains one of the only viable means for manufacturers to reduce rebate burdens and avoid exceeding product costs, especially under Medicaid inflation penalties.

Together, these presentations underscore the expanding role of real-world data and economic modeling in managed care pharmacy. From identifying persistent side effects of GLP-1 therapies to evaluating biosimilar adoption trends and assessing cost-effectiveness of novel mental health treatments, each study offers actionable insights for payers, providers, and policy makers.

Reference

Coetzer H, Dixon RW, Ganna S, Quillen S. Leveraging real-world data to advance managed care pharmacy practice. Presented at: AMCP 2025; March 31-April 3; Houston, TX.