Clinical
Pharmacy Practice News • January 2021
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Overcoming Biosimilar Hesitancy B
iosimilars have the potential to significantly reduce costs for medical centers, but the adoption rate is still very low. Fortunately, there are steps that pharmacists can take to increase use of these agents. At the end of 2019, 17% of the biologics market were accessible to biosimilars, but there was only a 20% adoption rate, noted David Crosby, PharmD, BCOP, BCPS, the pharmacy director of system infusion at Dartmouth-Hitchcock Health, in Lebanon, N.H. Including approved but not yet launched biosimilars, up to 50% of the biologics market could face competition from biosimilars, he said, citing data from IQVIA’s national sales perspectives (www.iqvia.com). There are six major challenges to biosimilar adoption, Crosby said during a session at the ASHP 2020 Midyear Clinical Meeting and Exposition: 1. Provider comfort and experience. There has been a fair amount of confusion among some providers about biosimilars, including unfamiliarity with development pathways, and confusion and concern because of a lack of interchangeability status. Just because biosimilars aren’t designated as interchangeable by the FDA doesn’t mean they should not be substituted for the reference product, Crosby said. “Partnering with provider section leadership to enhance education
and minimize inconsistency, but also to champion biosimilar rollout, is key to success,” he said. 2. Patient education. Such efforts are often needed because patients may have some misunderstanding regarding biosimilars, or be concerned when transitioning from a treatment they are familiar with that may be working well. “You really want to evaluate how pharmacy can supplement and support patient education to assist in that transition to biosimilars,” Crosby said. He added that patient education can overlap with provider outreach as well, since clinicians also may harbor negative attitudes toward biosimiliars. 3. Third-party payors. Most biosimilars developed so far are used primarily in outpatient settings, where individual agents require a prior authorization and benefits investigation. Ultimately, if a payor is not going to allow a biosimilar to be used, this can delay utilization. One reason is likely rebates the insurer may be receiving for the reference product, Crosby said. “We’re seeing more payors give preference to either the reference product or a specific biosimilar, and that’s based upon the rebate they receive. It’s a trend becoming more common over time.” This is an opportunity when negotiating payor contracts to ask that biosimilars be included as an option in your formulary, he said. “You may not be successful
each time, but they may be receptive since you’re really trying to identify cost savings for their beneficiaries.” 4. Financial impact on patients and organizations. Although the cost savings resulting from biosimilar use can be substantial, the bottom-line financial impact for patients and organizations is often much less significant or clear, with third-party payors deriving the greatest benefit, Crosby said. Still, that should at least have a favorable effect on premiums over time. This also can be an opportunity for the payor contracting team. 5. Clinical considerations. Biosimilars span therapeutic areas, and their use may involve multiple specialty and subspecialty providers. “This is where most [pharmacy and therapeutics committees] will need to develop policies, procedures and guidance to ensure consistency in your clinical approach,” Crosby noted. 6. Operational consideration. Even if everyone in your organization is on board with biosimilars and what they represent, if you don’t have a well-thought-out plan to operationalize the rollout, you may struggle to be successful, he said. Those challenges and caveats aside, biosimilars “are not a failed concept; they are in fact becoming a growing part of affordable treatment options available to payers, physicians and patients,” said Murray Aitken, IQVIA senior vice president
EDITORIAL BOARD
Savings, U.S. billions
Finance
18
19
104
2010-14
2015-19
2020-24
Cohort year
Figure. Biosimilar savings. Source: IQVIA National Sales Perspectives, Jun 2020; IQVIA Institute, Sep 2020.
and the executive director of the IQVIA Institute for Human Data Science, in an October 2020 report (bit.ly/34xNHDf ). “It is our estimate that biosimilars could reach $80 billion in aggregate sales over the next five years, including $16 to $36 billion in 2024,” with potential savings in excess of $100 billion (Figure). Aitken cited, as an example, the recent launches of biosimilar bevacizumab, trastuzumab and rituximab, which “are set to reach nearly 60% volume share by the end of their second year on the market, significantly higher and faster than prior biosimilars,” he said. —Karen Blum The sources reported no relevant financial disclosures.
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