Amanda Forys, MSPH: Do you think that a patient is considering—in oncology sometimes you hear the general sentiment that sometimes patients aren’t as worried about costs as they might be with a different condition because it’s oncology, and it just gets your attention and there’s so much attention to it. Patients will sometimes go to extremes to make sure that they’re able to cover the cost of their medication. I’m not saying they won’t in other diseases, but oncology is just kind of one of those special ones that really gets people’s attention and they’ll do what they can for their care.
What are patients looking for in terms of a cost savings, and is that alone—I know you talked a little bit about efficacy and feeling safe taking it—how much do you think cost plays in that decision to switch to a biosimilar or take one?
Christy M. Gamble, JD, DrPH, MPH: It really depends on the patient. You have some patients in oncology that are willing to take the risk, like you said: “Whatever it takes to fix or treat my condition or manage my condition.” But you have some patients who just simply can’t afford it. You have populations of color and low-income patients that are oncology patients but they can’t afford it.
That’s when the conversation comes down to what we call the 5 As of access: you have accessibility: is it easy for me to get this medication? Then you have availability: is it available to me immediately? You have accommodation: can I get to it at certain times, can I go to my local pharmacy—my 24-hour pharmacy—and access this drug? Affordability of course is key. When it comes to those that are insured, am I able to cover the co-pay? That’s where cost comes into play. And then acceptability: am I able to get this from my provider, [and] is my provider willing to offer this as an alternative?
So, there are so many different things that come into play; cost is just one of them. But it’s really the ease of getting to it. The least amount of barriers, the more likely you are to see a patient who’s willing to take a biosimilar versus those who are facing some significant barriers. Like I said, populations of color and low-income patients are more likely not to take biosimilars because of all of the barriers including cost that come into play with the therapy.