ASCO Posters Reveal Successful Approaches to Biosimilar Adoption in Oncology

Posters presented at the American Society of Clinical Oncology (ASCO)'s annual meeting showed the successful approaches health systems took to encourage greater adoption of oncology biosimilars.

One poster featured the development of an approach aimed at standardizing biosimilar utilization across Cedars-Sinai California locations that leveraged electronic health records (EHRs).¹ The EHRs were used to integrate with clinical algorithm pathways and patient financial information. The approach favored biosimilars by allowing them to be selected through the oncology Pharmacy and Therapeutics committee as part of the formulary development process.

Providers were allowed to exempt their patients from having their therapy substituted for a biosimilar within the electronic order sets. Patients were placed into 2 groups to assess the feasibility of substitution across enterprises. The main medical center group needed to have an 80% compliance rate and the affiliated sites group had to have a 75% compliance rate. The researchers said that the system provided a minimum detectable difference of 5.7% for the main medical center group and 8.9% for the affiliated sites group using an exact one-sided Binomial test.

From January to December 2021, the researchers identified 811 patients with cancer who started therapy with bevacizumab (Avastin), rituximab (Rituxan), or trastuzumab (Herceptin). Overall, 535 met the eligibility criteria for the analysis. The average substitution rate to biosimilars was 83% (range, 75%-97%) compared with the baseline rate of 55%, demonstrating a 51% improvement. The conversion rate was 85% for the main medical center group and 81% for the affiliated sites group.

Among the 92 patients who gave reasons for why they did not to switch to a biosimilar, 35% said it was because of off-label indications, 17% cited patient assistance programs, 15% said payer preferred alternative brand, 12% said their clinician preferred the reference product, and less than 1% cited the possibility for infusion reactions.

The researchers claimed that there was about $1.2 million per month, or an average of 23%, reduction in direct spending based on wholesale acquisition cost.

In another poster, Hematology and Oncology Pharmacy Association members were asked to complete a 40-question survey regarding biosimilars in formulary management, product usage, policies, technology, safety, and education.² Biosimilars for bevacizumab, filgrastim (Neopogen), epoetin (Epogen/Procrit), infliximab (Remicade), pegfilgrastim (Neulasta), rituximab, and trastuzumab.

In total, 179 surveys were distributed, of which 50 were completes, with 21 responses from comprehensive cancer centers. Formulary decisions for inpatient settings were driven by acquisition cost over reimbursement. For outpatient settings, acquisition cost and reimbursement were given equal consideration.

Regarding formularies, 32% of respondents restricted biosimilar use to indication approved by the FDA and 66% had a biosimilar interchangeability policy in place. The overall utilization for biosimilars was 74% for bevacizumab, 88% for filgrastim, 82% for epoetin, 57% for infliximab, 52% for pegfilgrastim, 73% for rituximab, and 71% for trastuzumab.

More than 90% of respondents said that they had a biosimilar listed as the preferred product on formulary lists. Additionally, 72% said that payers specified a biosimilar for the formulary and 76% said that payer reimbursement limited the ability to participate in contract pricing.

The main barrier to adoption was insurance reimbursement. Errors related to biosimilar utilization were reported by 26% of the institutions, with communication being cited as the biggest reason for the errors. Education on biosimilar use was utilized by 36% of respondents and 38% said that they included biosimilar products in treatment specific education.

Reference

1. Limvorasak S, Dobbs CL, Kim J, et al. Successful biosimilar adoption in oncology: strategic approach to system standardization. Presented at: ASCO 2022; June 3-7, 2022; Chicago, Illinois. Abstract e18605.
2. Reed M, Przespolewski E, Walsh MD, et al. Survey of biosimilar adoption across oncology pharmacy practices. Presented at: ASCO 2022; June 3-7, 2022; Chicago, Illinois. Abstract e18813.