Ali McBride, PharmD, MS, BCPS, clinical coordinator of hematology/oncology at the University of Arizona Cancer Center, discusses experience with biosimilar pegfilgrastim so far.
So we’ve already seen 2 biosimilars come to market. We have Udenyca and Fulphila, both drugs are FDA approved for the current indication for pegfilgrastim this setting. So we've seen the actual market start to develop. A lot of discussion has been utilized. We’ve seen some quick implementation for Fulphila and also Udenyca; many sites across the country are transitioning towards that, but also what’s going to actually be distinguished in this discussion is we’re also seeing payers put those biosimilars as a first-line suggestion for therapies in terms of not using the brand-name product.
As you move forward with these pieces, which payers will define what type of biosimilar they use or what maybe their step edits will be for treatment, then it will actually be up to the site or institution to put them in stock.
So if we actually see the emergence of 4, 5, 6 biosimilar pegfilgrastims in the market shortly, the problem will be, will each payer define what type of biosimilar they’ll use? That's going to be very tough for us or any institution any of our [Association of Community Cancer Center, ACCC] members out there, any of our cancer centers. They'll have to stock each one and figure out what type of biosimilar to use per patient.
What makes it worse, or even more confounding, is the amount of time that needs to be noted for that. For the technician, the buyer in this case, but also if you have maybe 5 different companies making biosimilars, and then you have 10 biosimilar lines—a rituximab, and Avastin, a Herceptin, you may have your short-acting growth factor and long-acting growth factor—you start to name these therapies as they evolve, if payers don't actually have a more concise attitude or discussion point for these biosimilars, it will make it very tough to address what pegfilgrastim you have, or if you need to carry many other pieces of that as well.