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BMCHS Worked Up to Biosimilars From Tbo-filgrastim


The Boston Medical Center Health System (BMCHS) of Massachusetts was able to achieve high adoption rates for biosimilars based on experience with a “nonbiosimilar.”

The Boston Medical Center Health System (BMCHS) of Massachusetts was able to achieve high biosimilar adoption rates, and those patterns began with the use of tbo-filgrastim (Granix), which was not approved as a biosimilar in the United States, although it was in Europe, according to Bhavesh Shah, RPh, BCOP, senior director of specialty and hematology/oncology pharmacy at BMCHS.

BMCHS’ first experience with “generic” biologics was with tbo-filgrastim, which they used for mobilization, the increase of stem cells in peripheral blood prior to collection for transplant in patients with cancer.

“That was our first experience of a biosimilar, but not approved as a biosimilar,” Shah said.

Tbo-filgrastim “set the pathway for other biosimilars when they were approved. We had a much faster adoption rate, where providers were comfortable using the biosimilars and understood the approval process, the indications, and all the testing that was done.” Their current biosimilar conversion rate is 98%.

Tbo-filgrastim was approved for marketing in the United States in 2012, before the biosimilar regulatory pathway was finalized. However, the drug was filed under the biosimilar pathway in Europe and is marketed as such.

Although, the United States has approved tbo-filgrastim for just 1 of 6 indications for reference filgrastim, many practices that use tbo-filgrastim prescribe it as if it were a biosimilar. In fact, a recent study found that 55% of tbo-filgrastim claims for employer plans were for off-label use.

To help boost uptake even more, BMCHS also looked to Europe, which has a 10-year head-start on the United States in terms of biosimilar adoption. Much biosimilar data come from European studies and the region is very comfortable with biosimilars.

When BMCHS was first trying to adopt an infliximab biosimilar they, “actually reached out to colleagues in Europe to get their input in regard to their experience because there was definitely some hesitation from our providers. There was actually a peer-to-peer conversation from Europe to the United States in this biosimilar adoption, so that was actually beneficial,” Shah noted.

Other practices and hospitals have struggled with adoption, as they’ve waited and taken longer to evaluate biosimilar data.

“For our hospital, we’re still evaluating the use of biosimilars, so we don’t have a large uptake in that perspective. But I have heard centers across the United States varying from up to 50% to 60% in this area,” said Marc Earl, PharmD, BCOP, director of pharmacy at Cleveland Clinic of Ohio.

Practices with already high biosimilar uptake rates may find it easier to justify switching a patient from a costly reference product to a more affordable biosimilar.

“They’re all essentially the same. If it’s a bevacizumab molecule, it’s a bevacizumab molecule, and you can basically use that at any time point. As long as the patient is supposed to continue that drug, you can basically substitute 1 bevacizumab for another bevacizumab,” explained Shah.

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