Dr Kashyap Patel: The Pros and Cons of Pegfilgrastim Biosimilars vs Neulasta Onpro

Cost and lack of insurance are big drivers of why a physician may choose to prescribe a pegfilgrastim biosimilar over the convenient on-body device for the originator, said Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care Associates.

Transcript

Do you think that the convenience of Amgen’s Onpro device for Neulasta outweighs the cost or safety benefits that pegfilgrastim biosimilars provide?

I always give patients the option if they want to use it. The challenge with that is, one, for patients who are actually underinsured, particularly, the almost 6 million Medicare beneficiaries who only have Medicare, which is about almost 19% to 20% of Americans in the retirement age group, for them, any increase in a cost could become a cost prohibitive. That is one.

We try to do our best to get them what we call the patient assistance program as much as we can, but a lot of time the foundations run out of the money. So, we want to minimize toxicity. And for safety, I definitely would expect that there may be small number of patients who may go for it even if they can't afford it. But we are not looking at 1 dose. I mean, we're looking at about almost 6 cycles of the treatment and any incremental kind of cost, even if it's just $200 per dose, could become a challenge because you have to remember these beneficiaries, they make very little money. They are maybe making $1400 a month, and then spending about $500 out of that for the entire duration of treatment, in addition to the out-of-pocket costs, could mean that they are losing a whole month worth of their income. So, there are many complicating factors.

The other thing is, in my area where I serve, patients are concerned about those, you know, the green light that says they can take the device home. So, technology and the cost, this too could become prohibitive, but it could also become very beneficial for people who are living in more affluent class, who are living in a society where they're more savvy to kind of different segments.

So, it's a mixed bag. But I do think it's very useful to have, particularly in the time of a pandemic, where we have an option of providing that for those who can afford it and those who are comfortable with the technology.