Bruce Feinberg, DO: Karina, the state Blue Cross Blue Shields are coming through. Actually, Blue Cross Blue Shield of Michigan was 1 of the earliest collaborators. I was doing some payer-pathway work in 2010, and they were already collaborating with private practices as well as institutions.
I look at this and Florida Cancer Specialists & Research Institute, and they’re not necessarily representative of the mainstream. Then we have Blue Cross Blue Shield of Michigan, and it was early in their collaborative nature and not necessarily representative.
I wonder how much of the story resonates if we were talking to every Joe oncologist who is out there and not in these practices or in states. Although Bhavesh said the numbers are pretty impressive in this early period in terms of adoption, it’s not the story I’m hearing on the street and in the market research work I do with Cardinal Health Specialty Solutions.
Do you think these are representative? You’re all involved in the national organizations. Do you think that because of your positions and your institutions or organizations that you’re in better shape than most? Anyone?
Karina Abdallah, PharmD: I’ll take that 1, Bruce. I do think that. Even within the Blue Cross Blue Shield system, I work as collaboratively as I can with the smaller state plans, which don’t have that big hole or years of experience that Michigan had, in terms of coming up with these collaborative agreements. Also, it is beneficial to have that designated department or area that is able to interface with not only the providers or the big health systems but also pharmaceutical companies on those rebate-contracting portions. It does get very complicated, and there are a lot of interests to deal with. A lot of the smaller plans, as you mentioned, really don’t have the dedicated staff or resources that are required to make these big offers and collaborations.
Kathy W. Oubre, MS: Bruce, to answer your question, I do think, because of where we all sit and what we do for a living, that we view this very different from what is probably going on in the much larger landscape. As I mentioned earlier, you really have to have that physician champion who is going to adopt biosimilars. I’m hearing hesitancy from oncologists because they’re very concerned about giving a product that’s similar when they have much more confidence with the reference product.
Some people are doing only new treats. A lot of people are not as forward-thinking as Dr Diaz and his partners at Florida Cancer. Then what do you do? Some people do only those new treats and then start to track them. They track them for adverse-effect profile, scan results, and those kinds of things, but you also passed that physician champion. You need to have a nurse champion; let’s not forget the nurses in this. There needs to be a lot more nurse education around biosimilars. Nurses take that relationship with their patients very seriously. They love their little patients and need to have confidence in the medicines they are giving their patients. They’ve been forgotten in this whole process a little.
You also need to have that administrative champion who is doing that modeling based on contract pricing, even just from a revenue-cycle standpoint, because we do build those things differently. You have to talk to your payers to make sure they’re covered. We track all our new drugs when they come to market. When we bill them, we track them differently. I’ve had revenue-cycle people come back to me and say, “We don’t give biosimilars because we won’t get paid.” That’s not my experience, but it needs to start at the top and it needs to work its way through the life cycle of a practice for successful adoption.