Bruce A. Feinberg, DO: You introduced cost. Do you really believe it will be a fraction of the cost? It raises the other issue, and you can all weigh in on this. What does that differential need to be? Is a delta of 10% going to be enough to really change behavior? Would it be enough for even a payer to really champion that cause? Does it need to be 30% in order to do that?
Do we have any examples that already exist? The one I can think of is in hepatitis C, but it really took one of the competitors to drop prices by 50% to change the market pattern. I’m curious as to what you think that may be and, in terms of how close that delta might be, how that won’t allow change or how wide it has to be to drive that change?
Hope S. Rugo, MD: From my perspective, the delta has to be at least 20% or more. That’s what people in the general field think. Being an academic oncologist, we really don’t think too much about cost, but we need to be thinking more and more about it. And I think that there is something unique about the supportive care products. You were talking about long-acting agents for rheumatologic diseases, but we don’t really have that in the therapeutic area of oncology. It’s just in supportive care.
You have a combination of what the cost is for the originator product versus the biosimilar in the short-acting area versus giving a long-acting drug, which already costs a lot more than the originator product, versus the 5 doses of filgrastim. So, it’s a complex basis, and sometimes I’ve had insurers come to me and say, “We’re not going to give you growth factor for this patient’s chemotherapy.” And I say, “Well, I can’t give them chemotherapy without growth factor,” and, “Look, here’s the papers that show the rate of febrile neutropenia.” We are really getting into an area where there is a lot of consideration about what people are going to approve up front. We have a lot of peer to peer discussions, now, with insurance companies about what’s going to get approved or not. It’s going to be very interesting to see.
Bruce A. Feinberg, DO: I’m curious. I’m hearing you talk about some of the kind of practical pragmatic issues of everyday patient care, and you’re at a renowned institution. And I’m thinking, when you talk to people in the community, are they suspect? You’re having those kinds of problems. You don’t know what problems are until you’re in a community practice with 3 doctors and you’re trying to deal with an insurance company. And so, I’m surprised by the fact that I’m hearing that recognition coming from your level—that higher position in the hierarchy of medicine in a major institution.