Jorge Garcia Talks About COVID-19’s Effect on Pegfilgrastim Biosimilars

The Center for Biosimilars® (CfB): I'm Tony Hagen, senior editor for The Center for Biosimilars®. COVID-19 [coronavirus disease 2019], has disrupted treatment for many patients across the health care spectrum. It comes at an inopportune time for the growth of the biosimilar market, which represents enormous potential savings for patients, as well as improved access to medicine. We spoke about this issue with Jorge Garcia, assistant vice president of the System Oncology Pharmacy Service Line at Baptist Health South Florida. Garcia is also a member of the Association of Community Cancer Centers' Board of Trustees. He discussed how biosimilar access has been affected by the pandemic and what we can look forward to.

During the United European Gastroenterology Week, we heard that mortality is rising, due to the fall off in doctor visits and cancer screenings. How is patient ability to afford care playing into all of this?

Garcia:Well, I think what's really important to recognize is that this year, throughout COVID-19, oncology patients have not been coming to see their oncologists or there have been less diagnoses been made. And that's been very relevant. In fact, we now try to just run campaigns to tell patients to not delay their oncology care, to come and receive their services, especially diagnostic services, that we have found ways of conducting those tests. So, I think it's hard to tell exactly how that's affecting their ability to afford care.

Perhaps this year, they are seeing less out-of-pocket costs associated with the amount of care that they receive. However, when they do come back, with potentially delays in diagnosis and in need of more complex care, there could be a delayed onset of expenses due to patients not getting health care as frequently as they probably would have, had COVID-19 not happened.

CfB: And, of course, with people losing their jobs, they have less family income. Are you hearing from your patients that this is an issue for them? Are they applying for more assistance through the doctors’ offices? How's that going?

Garcia:I think that makes a lot of sense. And we definitely have that theoretical concern. We have some patients who have lost benefits through their companies. And so, that always becomes an access issue. At that point, we actively try to work with pharmaceutical companies' programs designed to help patients when their financial abilities have changed. But, as you know, that could sometimes be a lengthy process or a process where patients don't quite meet criteria. So, there is a patient-by-patient assessment that needs to be done.

CfB: And do you think broader access to biosimilars could help with any of the problems discussed so far?

Garcia:I think in general, the core value proposition of biosimilars is to reduce cost and to maintain that same high quality of biologics. And I think [after 2020], given all of the added expenses and overall financial uncertainty for health systems in general, pharmacy leaders and other administrators are probably going to have more pressure than ever before to be able to be good stewards of health care costs in general. And, again, biosimilars are like a low-hanging fruit when it comes to achieving some pretty attainable cost savings within a drug class. Biologics are among the highest cost category when you compare them with all drugs. So, I do think that in the future, this may help with the uptake of biosimilar utilization.

CfB: Now, there's a low rate of adoption of biosimilars in the United States. How do you think this is affecting the real savings from these drugs at the moment?

Garcia:So, in the United States, we're only 5 years into this since the introduction of the first biosimilar filgrastim [Zarxio] in 2015. Almost 5 years in, we've seen that there is a relatively low uptake of biosimilar utilization in general. And there are many contributing factors to that. But when we look at the market opportunity, where a reference product is still being utilized but biosimilar options are available, we see that overall, not looking into any product specifically but looking at the entire market, the vast majority of that market opportunity has not been tapped into. So, I think that as health care leaders, it really lends an opportunity for us to try to rethink how we bring down barriers to be able to provide biosimilars an opportunity for higher market penetration.

CfB: Biosimilar access…what's happening at the clinic level that might be preventing patients from getting access to biosimilars? Not coming in for screenings might be one thing but, in the clinic, perhaps you haven't got enough time or [ability to] concentrate, because of other priorities, on biosimilar reviews and get doctors thinking in terms of trying new medicines.

Garcia:Yeah, you bring up a lot of great points there. So, in our existing oncology patient population, for those that already have a plan of care and receive infusions, we have not seen a significant drop in patient volumes. I think patients, relatively speaking, understand that although COVID-19 is a threat, not being compliant with their chemotherapy is also a threat. So, we have to keep a balance there. And, again, our infusion volumes have not been drastically impacted.

On the clinic side, for new patients is where we see a reduction in patient volumes, potentially from patients in the community that are standing by and trying to wait for things to be safer before they come seek out oncology care. And so, probably the initiation of new treatments in general, including biosimilars and other pharmacotherapy, is seeing a slow down with regards to new patients.

I also want to say that specifically for pegfilgrastim and the on-body [Onpro] injector, we are seeing that specific biosimilar sector has been more impacted because of our efforts to try to minimize the number of visits that the patients make to the cancer centers. And that on-body injector does provide the ability to avoid 1 visit. And so, I think in the pegfilgrastim space, the biosimilar options that do not have on-body [injectors], those are definitely seeing a reduction in utilization.

CfB: That's interesting. And we're heading into our first COVID winter, or maybe, hopefully, our last, but what we'll see is even more hesitancy among patients to seek treatment and even more careful measures by doctors, perhaps, to make sure that transmission does not occur in the clinic. Can you comment on how that relates to what we were just discussing about Onpro injectors?

Garcia:I think what we are probably looking at is as we continue to monitor this pandemic and as we see that the risk level is lower, practices will probably begin to shift back to more of the prefilled syringe products, because, again, that's where the cost savings are. We do not have an on-body injector biosimilar that allows us to have those cost savings. So, in the market today, the only on-body injector is the reference product [Neulasta Onpro], which we know comes at a premium cost.

So, I think as soon as the number of [COVID-19] cases begins to go down—of course, this is very specific to the geographical area—practices will probably try to make a determination as to when it's back to start shifting back to the prefilled syringe so that there could be those cost savings to the practice and to the patients themselves.

CfB: Are you interested at all to see how biosimilar usage patterns may change once the data emerges on the pandemic and how that has affected drug use across the board? Or are you already seeing signs? You just described pegfilgrastim, which is a great example, but is there anything else that you're seeing in terms of usage or anticipate?

Garcia:[I haven't seen] a clear trend on how the pandemic is specifically playing a role in biosimilar adoption. I would probably anticipate that overall this year we have seen a slowdown. We are not going to conferences in person. We are not having discussions as actively as I have seen before in the marketplace to transition to new biosimilars.

You mentioned something that is key before and that is that there's a number of different priorities this year. And so, on the practice side, the leaders that would lead a biosimilar implementation have a number of other things they need to worry about. And so, I think from that standpoint, we are probably seeing less efforts and energy being devoted to the implementation of biosimilars overall. Probably next year, as we get a vaccine and probably move more into our plan for how we transition our practices back to normal, I think biosimilars will be a part of that agenda. How do we transition back to normal with some cost savings along the way?

To watch part 2 of this interview, click here.