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COA Study: Biosimilars Have Broadened Patient Access in Oncology


Kathy Oubre, MS, a cochair of the biosimilars committee of the Community Oncology Alliance (COA), explains findings from a broad study of biosimilar use in oncology practices.

Biosimilars in the United States have seen perhaps the greatest uptake in oncology, but the use of biosimilars in oncology has also broadened access, meaning that competitive pricing of these agents, relative to reference products, has enabled more patients to receive treatment, according to a recent study of biosimilar administration at 122 practices by the Community Oncology Alliance (COA).

“A few years ago, when biosimilars were entering the market, several COA practices started using these, and we started to see savings anecdotally within our own organizations,” said Kathy Oubre, MS, CEO of the Pontchartrain Cancer Center in Louisiana and a cochair of the biosimilars committee at COA.

“We as an organization decided to take this a step further and look at this from a broader perspective, with a working hypothesis that biosimilars were going to play an integral part in bringing down health care costs,” she said in a presentation at the COA 2021 Payer Exchange Summit.

For the study of biosimilar use, participating practices submitted data for over 2 million administrations of reference and biosimilar products, and in the analysis, COA focused on rates of biosimilar adoption, administrations, and access to care.


In 2019 there were 68,000 administrations of Rituxan, the originator product for rituximab. The first rituximab biosimilar was Truxima, launched in November 2019, and this accounted for 19% of administrations in the first quarter of 2020.

Biosimilar rituximabs achieved a greater presence in the market with the launch of Ruxience in January 2020, and by the fourth quarter of 2020, rituximab biosimilars accounted for 55% of all rituximab administrations, Oubre said.

There were 112,000 administrations of rituximab in 2020, and 66,000 of those involved the reference product and the remaining 46,000, biosimilars. Oubre said this amounted to an increase of 44,000 administrations from 2019 to 2020, so access to care had sharply improved within the practices included in the study.


In 2019 there were about 23,000 administrations of both reference (Remicade) and biosimilar infliximab, and of those, 20,000 were reference product administrations. At that time, biosimilars accounted for a small percentage of administrations, but the presence of infliximab biosimilars began to grow. In 2020, Remicade administrations added up to 21,000—a 5% increase—but biosimilar administrations were significantly higher, 5000, reflecting growth in biosimilar share of administrations and also an increase in access to care with infliximab, Oubre said.


In 2019, there were about 120,000 administrations of pegfilgrastim, and 100,000 of those represented reference product (Neulasta) administrations. But in 2020, the number of administrations climbed to 139,000 in total, with 98,000 (a decline) being reference drug administrations and 41,000 being biosimilar administrations. “So, quite a large increase,” Oubre said.

“Within our organization [Pontchartrain], biosimilars have offered us a lower-cost alternative without sacrificing any quality for our patients. Therefore, we continue to see increases in access to care,” she said.

The first pegfilgrastim biosimilar entered the market in July 2018 and by the fourth quarter of that year had a 2% share of the market. By the end of 2020, pegfilgrastim biosimilars had a 31% share, Oubre said. There were 4 available biosimilar pegfilgrastims by that point.


The first trastuzumab biosimilar (Kanjinti) was launched in July 2019. In the fourth quarter of 2019, there were roughly 24,000 administrations of trastuzumab, and about 16,000 of those were the reference product (Herceptin), and 8000 were biosimilar administrations.

In 2020, the quarterly administrations overall were about the same, 24,000, but “we noticed tremendous biosimilar uptake, with 65,000 administrations of biosimilars and a significant drop to 29,000 administrations of the originator product,” Oubre said.

“To put a finer point on it, biosimilars accounted for 35% of all the trastuzumab administrations in the fourth quarter of 2019, and that quickly grew to 79% of all administrations by the fourth quarter of 2020,” she said.

Kathy Oubre, MS

It's our working hypothesis that these market shifts are likely a combination of patient acceptance, physician confidence, and a growing demand from patients as well as physicians to find ways to bring down health care costs.


Bevacizumab biosimilars entered the market in July 2019 and in the fourth quarter accounted for 8000 of the overall administrations of this product, vs 21,000 for the reference product (Avastin). In 2020, there were roughly 31,000 administrations of bevacizumab per quarter, which breaks down to roughly 13,000 reference product administrations vs 18,000 biosimilar administrations.

Bevacizumab biosimilars achieved a 29% overall share of administrations in the fourth quarter of 2019 and by the end of 2020 they accounted for a 72% share, Oubre said.


“These market shifts are likely a combination of patient acceptance, physician confidence, and a growing demand from patients as well as physicians to find ways to bring down health care costs,” Oubre said. “Biosimilars offer quality without compromise, and at a cost savings to the patient, physician practice, and the overall health care ecosystem.”

Oubre said that these findings run counter to assertions that biosimilars haven’t delivered on their promise. “Earlier this year there was an op-ed in the New York Times in which the author argued that we should throw in the towel on biosimilars. As I hope we have shown you today, that argument is premature.”

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