Bruce Feinberg, DO: In your experience with patients, if that cost difference isn’t directly impacting them and it’s something that seems less obvious, like the drug’s list price is lower but your out-of-pocket is the same, where it doesn’t translate in any way to a lower premium cost for you, is cost a factor for patients? Are the doctors putting themselves in a position of trying to make the case? It’s almost like, “Why do I want to go down that rabbit hole?”
It’s no difference for the patient. They don’t really understand it. It’s too hard to explain. If it’s going to cost the patient $1000 less, it’s a great story. When there is no impact on the patient, what is that incentive for the physician to go down that path, which raises that question about OCM [Oncology Care Model] shared risk?
Michael Diaz, MD: Yes, that’s another fair question. We usually don’t know what patients’ economic thresholds are, and so we tend to have the discussion with them in the first place. In some situations, very rarely, you might have a patient say, “Well, doesn’t make a difference in my co-pays. I don’t pay anything. I want the brand-name product.” That’s not the case, and we’re not seeing that as much anymore.
They’re also trying to take into account the cost of care to the system. I am seeing that more and more patients are more socially aware that they do have a bit of an obligation to try to make sure that they’re making the right call for society as well. Even though it makes no difference to them economically, that helps their insurance company, or whoever is paying the bill on the other end. It helps them make better use of their dollars. We’re starting to see that more and more with patients, as we have these discussions, but if you don’t have the discussions, you won’t know, and that’s the thing.
Bruce Feinberg, DO: I want to get Kathy’s thought on this, because at Pontchartrain Cancer Center, you’re obviously seeing a lot of patients come through. Is there any gestalt or sense that patients are more socially aware in regard to the cost?
Kathy W. Oubre, MS: Yes, I was going to echo what Dr Diaz said. We are seeing that. We have always been early adopters of biosimilars, and to Dr Diaz’s point, it is part of that ethical or moral idea of being able to lower the costs for that system and for the patient.
We are having those conversations with patients. Biosimilars are very important at the beginning of a year when patients’ deductibles reset. During that time, it’s really nice when you’re having to make those decisions, as those patients are, between rent and paying for their therapy and all those other factors. Financial toxicity is real, and it continues to grow and be more entwined in the fabric of medical care every single day.
To go back a step or 2 to your larger question, we are seeing patients be more socially aware. It is hard to turn on the news, prior to COVID-19 [coronavirus disease 2019], and not see health care and those costs be part of that news, so they do understand that. Very rarely do we see a patient argue for an originator, even if it costs someone more, because at the end of the day, there is still an extremely healthy respect for that physician-patient relationship and the shared medical decision-making between that physician and their patient.
Bhavesh Shah, RPh, BCOP: The way I like to explain it to a patient is that they may not actually see the direct cost sharing right now, but the way a payer looks at it is per member, per month, right? How much they are spending right now is going to determine what your premiums are for next year. I think that if you’re able to lower the cost now by taking on a lower-cost option, you’re probably changing your deductibles and premiums in the future.
If you look at Medicare, which is the biggest payer, unfortunately, those are the patients that get hit the hardest because they are responsible for 20% on the infusion side. If you think about it, if you have a biosimilar that costs 40% less and Medicare is spending a billion dollars on that drug, you’re actually saving Medicare $400 million by switching to that biosimilar. That means next year, they are not going to increase the premiums and deductible for Medicare patients by 7%, which is what they did this year.
Karina Abdallah, PharmD: Just to echo a bit what Bhavesh just said, insurance design is definitely at the point now where it is coinsurance. It is very similar to what Medicare implemented many years ago. Most private payers are also beginning to move into the coinsurance versus co-pay insurance design when it comes to anything that is a specialty drug or high cost.
To your point, Bruce, that really does hit that patient aspect as to their total out-of-pocket costs. We have to work together to get that message across so they can definitely benefit.