Oncology Practices Made Shifts Toward Biosimilar Use, but Payer Challenges Remain

At the end of 2022, more than half (22 of 40) of the approved biosimilars in the United States were used to treat cancer or for supportive care for patients with cancer. Two abstracts presented at the 2023 American Society of Clinical Oncology annual meeting evaluated biosimilar adoption across oncology practices.

The first abstract analyzed the impact of regional clinical pharmacists (RCPs) on selecting the most cost-effective biosimilar products in a large oncology network of 107 oncologists across 76 locations and 17 states.¹ The network had implemented a program in October 2021 in which RCPs acted “as a liaison between providers and financial teams to evaluate existing drug orders and their financial impact.”

After 1 year of the program, more than 90% of bevacizumab, trastuzumab, and rituximab orders were for the preferred product. Prior to the program, use of preferred pegfilgrastim was less than 20% in April 2021 and by December 2022 it was above 60%. From April 2021 to April 2022, use of preferred filgrastim had increased from less than 75% to greater than 90%. However, it had decreased to 55% by the end of 2022 as a result of trending average sales price.

The program resulted in significant cost savings. Throughout 2022 there was $56.5 million in total savings—$26.4 million for payers, $23.5 million for providers, and $6.6 million for patients.

Insurers have a role in biosimilar use and can impact biosimilar selection or reduce use of biosimilars through policies.

The authors noted that in one-third of cases, payer preferences prevented biosimilar switching.

“Barriers to switching to institution-preferred products included non-medical switching requirements by payors, patient assistance and compassionate use programs, and patient and/or provider preferences,” they noted in conclusion.

In the second abstract, the authors conducted a 40-question survey to understand the current state of biosimilars in oncology practices, as well as barriers to uptake.² The surveys evaluated formulary management, product usage, policies, technology, safety, and education and the biosimilars for bevacizumab, filgrastim, epoetin alfa, infliximab, pegfilgrastim, rituximab, and trastuzumab.

A total of 50 survey responses were included in the analysis, of those 21 (42%) were from National Cancer Institute–designated comprehensive cancer centers.

The responses revealed:

• Formulary decisions were driven first by acquisition cost and then by reimbursement in the inpatient setting and equally by acquisition cost and reimbursement in the outpatient setting.
• 32% only used biosimilars for the FDA approved indications
• 66% had an interchangeability policy
• More than 90% had a preferred biosimilar on formulary

Payers impacted biosimilar use for the respondents: 72% said payers specified biosimilar selection and 76% said payer reimbursement limited the ability to participate in contract pricing. In addition, the main barrier to biosimilar adoption was insurance reimbursement (82%), according to respondents, followed by drug availability (24%) and computerized provider order entry (24%).

Filgrastim had the highest biosimilar use at 88%, followed by epoetin alfa (82%). In comparison, pegfilgrastim had the lowest adoption at 52% followed by infliximab at 57%.

Communication was the main cause for medication error related to biosimilar use and was reported by 26% of respondents.

Despite noted utilization shifts toward biosimilars compared with the reference product, there remain areas for continued improvement, the authors noted.

“Opportunities exist in the collaboration of health systems and payors to align formularies and promote safe and cost-effective care for their members,” they concluded.

References

1. Chang M, Li J, Peters B, et al. Biosimilar uptake and cost savings analysis before and after implementation of a pharmacist-driven substitution program within a national community oncology network: one-year follow-up. Presented at: 2023 ASCO Annual Meeting; June 3-5, 2023; Chicago, IL. Abstract 6516. doi:10.1200/JCO.2023.41.16_suppl.6516

2. Reed M, Przespolewski E, Doughty Walsh M, Amsler M, et al. Survey of biosimilar adoption across oncology pharmacy practices. Presented at: 2023 ASCO Annual Meeting; June 3-5, 2023; Chicago, IL. Abstract e188813. doi:10.1200/JCO.2022.40.16_suppl.e18813