Leveraging the EHR to Automate Biosimilar Selection

This is the first blog post in a 6-part series recognizing the achievements of the 2024 ACCC Innovator Award winners before their in-depth sessions at the ACCC 41^st National Oncology Conference. You can learn more about the innovations being recognized this year and those who pioneered them by joining ACCC in Minneapolis, Minnesota, from October 9-11, 2024.

Biosimilars are projected to reduce spending on biologic medications in the United States by approximately $54 billion between 2017 and 2026. However, a challenge associated with the increased utilization of biosimilars is the complex prior authorization and step therapy process for commercial payers. To address this issue, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute developed an electronic health record (EHR) tool to automate the election of a preferred biosimilar based on the patient’s insurance and the cancer program’s formulary preferences.

This initiative landed the cancer program a 2024 Association of Cancer Care Centers (ACCC) Innovator Award. Looking forward to the ACCC 41^st National Oncology Conference (NOC) this fall, ACCCBuzz spoke to Sarah Hudson-DiSalle, PharmD, RPh, FACCC, assistant director of Reimbursement Services at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, to learn more about their program.

ACCCBuzz: How long has The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute been an ACCC member?

Dr. Hudson Di-Salle: We are going on year 31. We received the 30^th year award at the last annual meeting. 

ACCCBuzz: What is your favorite part of being an ACCC member?

Dr. Hudson Di-Salle: It is the multidisciplinary membership of ACCC. It helps to see the various problems or solutions from different aspects. So, whether it's, our physician’s, or APP’s [advanced practice providers], or our social work, nursing or administrative teams, and our advocacy group, there’s a collection of solutions. And it could be that each area is having symptoms of that same problem. For example, burnout was a major issue that ACCC devoted a lot of efforts towards. But it wasn't an answer just for physicians, it was an answer that could be applied to all those disciplines across the health care spectrum. ACCC understands that every member of the cancer care team has an important role to play.

ACCCBuzz: What makes your cancer program unique?

Dr. Hudson Di-Salle: I’ve been with Ohio State [University] for 23 years and with The James [Cancer Hospital and Richard J. Solove Research Institute] for 20 years. A lot of the work that I do is around patient advocacy, access, and reimbursement of medications. When I came to The James, they were looking to help patients access medication in the early 2000’s. The term financial toxicity wasn’t even coined at the time. The mission at Ohio State and how we care for our patients is one of the main reasons I have stayed at Ohio State and continue to be passionate about the work I do. We make sure patients can access comprehensive subspecialized treatment. At The James, each cancer care team is built around a provider’s specialty, and their entire focus is on patients within that disease state.

Since we are an academic setting, learning, and teaching are important parts of who we are. I think it started with Arthur James and how he wanted to develop the care delivered here. I have watched The James grow from a small comprehensive cancer center to the program that it is today. We have such a large footprint in research and diagnostics. It’s a pretty special place. My dad was treated here, he had CML [chronic myeloid leukemia] and prostate cancer. I’m from a small town, so he was in awe coming to the big city, but when he came, he felt special. That is how every patient feels when they come—they’re treated like family. As big as we’ve gotten that is still a point of pride with our teams. It’s just one of the things that makes The James a great place to work and get care.

ACCCBuzz: How have these traits helped you win this award?

Dr. Hudson Di-Salle: The pharmacy department at Ohio State and the James has a long tradition of being curious and pushing the envelope. We’ve had specialty practice pharmacist since the beginning at The James and now most of our clinics have specialty practice pharmacists that work within the care team. That same type of curiosity allowed us to win this award because we knew there had to be a better way to handle the prior authorization process. Achieving the best is always the expectation in everything we do.

ACCCBuzz: ACCC President Nadine J. Barrett, PhD, MA, MS, centered her theme on Reimagining Community Engagement and Equity in Cancer. What elements of your innovation reflect this theme?

Dr. Hudson Di-Salle: With receiving biosimilars some patients can’t afford their copays. In those cases, we try to enroll them in copay assistance programs or grants, especially if those patients indicate concern about affordability or we check their benefits and discover a patient has a large out of pocket [cost]. We make sure our medication assistance team screens that patient and looks for resources. We have heard many stories within the ACCC Financial Advocacy Network, and you don’t want to have a patient on a payment plan for the rest of their lives. That is really a stressor and a burden that negatively impacts patients as they go through therapy.

ACCCBuzz: What can attendees expect from your session at the ACCC 41^st National Oncology Conference?

Dr. Hudson Di-Salle: We would like to share what we’ve learned in putting this kind of model together. This model has decreased our turnaround time to authorization, decreased administrative burden, and helped to decrease write-offs. For many [cancer] centers, using that rule-based system and picking what agent is needed, significantly increases efficiency. So, at the time the physician meets with a patient, they can pull up the plan and know what biosimilar they are dealing with if that’s the case and provide the education on the biosimilar product. It is a huge game-changer in time management.