Most patients are not necessarily aware of biosimilars yet. It's still very new. It's still new for the practitioners. When it's explained in a fashion that they can understand, they've been overwhelmingly enthusiastic and supportive about it.

Videos

Lee Schwartzberg, MD, FACP, executive director, West Cancer Center, discusses how patients are responding to using biosimilars.
 

Lee Schwartzberg, MD, FACP: Biosimilars and Patient Attitudes 

I think education around what biosimilars actually are. So, the physicians I talked to give me a great analogy that they're using biosimilars right now; because of the way these monoclonal antibodies are made, one batch of Rituxan is different right now then a batch of Rituxan, you know, made 2 years ago. So essentially you're using a biosimilar right now and as long as there's a cost incentive to use cheaper therapies, I think the consumers are going to look at it just like you look at generics. That’s what I believe is going to happen.

Tesh Khullar, senior vice president and advisor, Flatiron Health, discusses biosimilar education for patients and providers.

Tesh Khullar: Biosimilar Education in Oncology

So each of our clinical leaders, including Drs Vacirca, Patton, Brooks, and of course Schwartzberg, have been engaging their practices from a communication, education, training, and orientation standpoint, to really equip their clinicians to understand the clinical efficacy and availability for the patients they're serving, both initiating new therapy as [well as] those that might well be in the midst of therapy today. It's really a full-force effort on our part, to bring that kind of understanding across the clinical team.

Tracy L. Bahl, president and chief executive officer of OneOncology, discusses the education his organization has provided to physicians on biosimilars.

Tracy L. Bahl: Educating Providers on Biosimilars

I think it's a great question and potentially one that has room for exploration. What we do know is that certain biologic medications are weight-based dosing, like infliximab has a weight-based infusion dosing, whereas medications that are the subcutaneous injections often have a preformed or predosed administration.

And so with adalimumab, one thing that we do know that impacts the pharmacokinetics of the medication is body mass, and so we do think that there may be some potential loss of efficacy in patients who have a higher [body mass index, BMI]. So it's one of the considerations when we go about choosing a treatment strategy, but also monitoring that treatment strategy moving forward is BMI and how does it impact the potential disease state.

Benjamin Click, MD, staff gastroenterologist, the Cleveland Clinic, discusses the role of body weight in treatment outcomes for inflammatory bowel disease (IBD).

Benjamin Click, MD: Body Weight and Treatment Outcomes in IBD

I would say, right now, the oncology biosimilars in the therapeutic space is still new and limited. It's only been a few months since we've had the first 2 become available in the market that's not in supportive care.

Thus far, it's been, from at least a health system perspective, it's been a slower uptake and utilization. But part of that is because there is the awareness and increasing awareness from stakeholders about when additional products are going to be coming to market.

So for these oncology disease-modifying agents, there's an awareness that there's going to be additional ones coming out in the next few months. So instead of making a decision at the point in time when the first ones are launched, if you know there's going to be more coming out in the near future, a lot of health systems are waiting to see, okay, well, let's make that decision at that time to see what's going to be the most viable and financially positive for us to utilize.

Sonia T. Oskouei, PharmD, vice president of innovation and solution development at Premier Inc, discusses how anticancer biosimilars have played a role in oncology in 2019.
 

Sonia T. Oskouei, PharmD: Anticancer Biosimilars in 2019

We've been using supportive care biosimilars for a couple of years now; the supportive care drugs tend to be slotted in a little different way in some practices. They're chosen at the practice level rather than at the regimen level, so that they're organized to go into different categories of regimens rather than individual regimens.

Of course, physicians pick the regimens with therapeutics, so a little different, they're a little different slant. But again, the comfort with using the supportive care regimens, the principles are the same. You have a drug, you've manufactured a drug that's highly similar, that's going to work the same, whether it's in supportive care or therapeutic. If you trust that, you can use it.

Lee Schwartzberg, MD, FACP, executive director, West Cancer Center, discusses what oncologists have learned from experience with supportive care that can be applied to adopting anticancer biosimilars.
 

Lee Schwartzberg, MD, FACP: Lessons Learned From Supportive Care Biosimilars

Absolutely. I think so. I think that community oncology needs to embrace biosimilars. I think we have to make sure everybody's on the same page with how you consent patients for biosimilars. I think you have to understand what a biosimilar is, and that also is difficult for some practices to understand the interchangeability of that, but I absolutely think they can hit the goals. I absolutely think that biosimilars are going to transform the way we can participate in value-based contracts, whether it's OCM or a value-based contract with a payer.

Erich Mounce, chief operating officer, OneOncology, discusses the role that biosimilars will have in practices meeting Oncology Care Model (OCM) goals.
 

Erich Mounce: Biosimilars and the OCM

Absolutely. So within the biosimilar marketplace, it's projected to be $54 billion in savings over 10 years, and what we've seen, for example, is biosimilars have had some of those savings. Zarxio, filgrastim, was one of those products that in less than 2 years actually has saved over $500 million for patients. The FDA has been active in approving biosimilars. So in 2019 already, 7 products have been approved for now a total of 23 products.* And what also we've seen in 2019 is the FDA is even getting more involved with patient education, and in even moreso with provider education.

Brian Lehman, MBA, MHA, RPh, director, Medical Account Management and Strategic Alliances, Sandoz, discusses positive developments for biosimilars over the past year.

Brian Lehman, MBA, MHA, RPh: Progress for Biosimilars in 2019

So biosimilars really have had a significant impact at innovation in general, including oncology. And so here's my perspective: I think it not only represents innovation but it also fosters innovation.

So biosimilars, the regulatory pathway, the Biologics Price Competition and Innovation Act, innovation’s in the name, was really innovative to create an expedited pathway to bring these life-saving biologic therapies to market sooner. So not only was the regulatory pathway innovative with creating the concept of extrapolation and relying on the totality of evidence to be able to do so, but also the manufacturing process for these biosimilars represent innovation.

The technology and the ability to develop these biologics have come a long way even since the originator biologics were First developed. Now the way that biosimilars have fostered innovation and continue to do so, we could see it even from the originator biologics, we could see enhanced formulations or even dosage form. So, biologics that were traditionally infused are now available [subcutaneously] to other areas that we see it fostering innovation is even in the health system setting.

Creating these biosimilar strategies and processes from a health system perspective has really catapulted the development of a true education program within health systems to ease the transition to a biosimilar or start a new biosimilar for a new patient. A lot of time that's that goes with educating nurses, physicians, pharmacists, really a multi-stakeholder approach, and really keeping the pressure patient at the forefront of it.

Being able to create the process where patients are notified, educated on what these products are, why it's okay to be switching, and the potential impact it could have on out-of-pocket costs and the finance is really important, and that's represented innovation from a process standpoint within health systems too.

Sonia T. Oskouei, PharmD, vice president of innovation and solution development at Premier Inc, discusses how biosimilars have impacted innovation in oncology.

Sonia T. Oskouei, PharmD: Biosimilars and Innovation

At Tennessee Oncology and OneOncology, we have wholly embraced the change to biosimilars, mainly due to the cost savings to society. You know, everybody talks about the cost of drugs, and we as providers sometimes have the finger pointed at us, but we don't price drugs. Manufacturers do. We just use the right drug.

This is one chance that we've had where we can influence the cost curve, and so we have wholly embraced biosimilars, we will wholly embrace rituximab, and I think it's good for our patients and it's good for society.

That cost savings is not just to the payers. It also flows down to our patients, and so we're big fans of biosimilars.

Jeffrey Patton, MD, chief executive officer of Tennessee Oncology and president of physician services for OneOncology, discusses adoption of biosimilar trastuzumab, bevacizumab, and rituximab. 

Interviews