In early 2020, I think what I'm going to be very interested in seeing is how the market responds to having multiple biosimilars in certain their therapeutic areas. We're already seeing it with the pegfilgrastims now. There's more and more becoming available, and there was just one approved yesterday.* So to understand how health systems are going to really make the decision between multiple options for biosimilars is what I'm going to be really looking out for, and whether or not it's really going to come down just to the price, if there's going be any differentiator as part of it I think will be interesting to see.

Videos

Sonia T. Oskouei, PharmD, vice president of innovation and solution development at Premier Inc, discusses what she will be watching closely in the biosimilars space in early 2020.
 

Sonia T. Oskouei, PharmD: Biosimilars in 2020

We're seeing, and Amgen was the first one to do it, where they went right to the payer. They went to UnitedHealthcare and made sure that their not only branded Neulasta but their biosimilars are on preferred therapy for UnitedHealthcare, which then dictated down to practices needing to utilize it for United Healthcare patients.

So what you're going to see, in our opinion, are biosimilar manufacturers going to payers, getting them on formulary. It's actually going to be a big problem for community oncology. From a financial perspective, it's going to be an opportunity, but the logistical problems of having the brand of biosimilar different by payer is going to be an operational nightmare to manage.

Tesh Khullar, senior vice president and advisor, Flatiron Health, discusses challenges with reimbursement for biosimilars in community oncology practices.

Tesh Khullar: Reimbursement for Biosimilars

So, I do think bringing down the cost of therapy is important. It has to be affordable—these patients are usually on it for long periods of time. This is a chronic illness, so we are dealing with the healthcare value-based system as a whole. I do think that biosimilars, in my mind, when they were first being developed, was that they would have huge cost savings. So, in my mind, huge cost savings is not 10%, 20%, 25%, which is what we’re seeing. To me, huge cost savings is at least slashing it down by half. Half price&mdash;50%, right? So, I’m not seeing that.

So, I do think that it’s not as cost saving as I had hoped. So, it’s a little bit of a letdown when I’m only seeing a small percentage decrease in biosimilars.

Elaine Husni, MD, MPH, vice chair and director of the Arthritis and Musculoskeletal Center in the Orthopedic and Rheumatologic Institute at the Cleveland Clinic, discusses whether biosimilars are generating cost savings for patients with inflammatory diseases.

Elaine Husni, MD, MPH: Biosimilars and Cost Savings for Patients

Yes, absolutely. So that's something that we work really hard with our utilization management team on we want to make sure that they have all the information available, because they really are kind of clicking those clinical boxes that says whether something should or shouldn't be supported.

So when they're when they're putting in that prior authorization information that they have everything they need to make the most appropriate selections, so that then there's less of a holdup, or denials, or things that have to go to peer-to-peer. We want it to be as smooth of a process as possible.

Rhett Wilkerson, associate director of patient financial services, Florida Cancer Specialists, discusses how utilization management strategies impact patient access to biologics. 

Rhett Wilkerson: Prior Authorization and Patient Access

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.

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.
 

Interviews