Ryan Haumschild, PharmD, MS, MBA, director of pharmacy services at Emory Healthcare and Winship Cancer Institute, provides an overview of biosimilars in the breast cancer space and lingering adoption barriers for oncology biosimilars.
Haumschild's comments came at the end of Breast Cancer Awareness Month and the beginning of Global Biosimilars Week, an annual biosimilar awareness campaign hosted by the International Generic and Biosimilar Medicines Association.
With October being Breast Cancer Awareness Month, what more is needed from providers and health systems to ensure patients have adequate access to biosimilars for breast cancer?
I think access to biosimilars is really important. It drives down the cost of care and I think allows more patients to be on treatment. But there's still some unanswered questions that exist. How do we get these biosimilars implemented into our EMR [electronic medical record]? What happens when some biosimilars are no longer covered by payers and we still want to utilize them? How quickly can we change a lot of our order sets?
And then again, how do we educate some patients that might be concerned. They might be in curative intent. Do we have the proper education to make sure that patients understand that biosimilars are equivalent to the reference product and still provide great outcomes for them? Especially in their cancer journey for breast cancer. [We need to] let them know that they might interact with biosimilars throughout a variety of different treatment options, and they're still going to give durable responses.
I think once we get that education out, learn how to implement these biosimilars in a timely manner, we'll be a lot more successful, specifically in our breast cancer population.
What role can biosimilars for breast cancer play in improving breast cancer treatments overall?
I think biosimilars, again, will continue to provide more treatment options for patients at a lower cost. And I think that's a great thing. I think when you're creating more equitable access—you think about diversity, equity, inclusion in breast cancer—there's still a lot that we have left to accomplish. And so if we can leverage biosimilars, whether in combination or for supportive care, more patients can get on treatment or reducing the cost of the care to the provider. That's a great thing.
When we think about value based care of breast cancer, we think about EOM [Enhancing Oncology Model] and some of those value-based care models, the more that we can leverage biosimilars and those frameworks. I think if we make more sustainable models of care, we can bring care out to the community or to patients directly
Also, can we consider [biosimilars for] home infusion or supportive care medications that patients can take at home? I think the more we can do that, and the more we make accessibility one of the key drivers, I think that's going to create better uptake for breast cancer patients as a whole and I think that's something to get excited about.
Studies have shown that oncology and supportive care biosimilars are the biosimilars with the highest market share and providers are very comfortable using these products. What are some of the main challenges still facing oncology biosimilars?
Biosimilars have good uptake now and I think there's a lot of excitement. Actually, I think oncology and maybe breast oncologist are one of the main leaders in adopting these therapies. But I think as we start to utilize them, we're seeing a little bit more difficulties, sometimes from the reimbursement side. So, if you look at net cost recover—if you're a large community oncology practice or health system—the average sales price continues to trend downward. And unfortunately, that's really difficult because that's the reimbursement for a lot of these practices. If there's no margin, there can always be the same mission.
I think at the same regard, when we're utilizing these therapies, how many denials are we getting from our payer colleagues because we're not using the preferred biosimilar? And there's that slow down time to treatment. And when I think about breast cancer patients, we're really thinking about overall survival and progression free survival. So, every day and every minute counts for how quickly we can get them started on treatment. And the more we see delays there, I think that also influences treatment.
Lastly, biosimilar uptake is important, but now we're seeing the reference products being reformulated to subcutaneous products. And so I think subcutaneous and a faster infusion sometimes might be more warranted, and then also kind of limits the growth of biosimilars into some of those therapeutic areas.