Industry Experts See Need for Greater Education, Deeper Discounts for Biosimilars

On Thursday, the Oncology Business Review (OBR) hosted a panel discussion, “The Advent of Biosimilars in Oncology: Planning Proactively for Change.” The webinar featured biosimilars thought leaders, including Steven B. Miller, MD, senior vice president and chief medical officer of Express Scripts, and Christina Corridon, associate principal of ZS Associates, who gave their thoughts on the future of biosimilars.

“2017 is going to be a great year for approvals,” said Miller, noting that there are 12 originator products with biosimilars in development, representing a potential $38.5 in sales at stake. He identified the following products as having competition within the biosimilars space:

• adalimumab
• rituximab
• etanercept
• pegfilgrastim
• trastuzumab
• infliximab
• bevacizumab
• insulin glargine
• epoetin alfa
• darbepoetin alfa
• cetuximab
• palivizumab

Miller projected that biosimilars could generate approximately $250 billion in savings through 2024, assuming that products are priced at a 30% discount to originator products, and that no patients currently receiving reference products would be switched to biosimilars (as interchangeable status has not yet been granted to any biosimilars).

In describing the awareness of, and attitudes toward, biosimilars in the oncology marketplace, Corridon discussed an as-yet unpublished survey conducted by ZS Associates, that assessed the education level and perceptions of biosimilars among 252 respondents (200 oncologists, 25 payers, and 27 pharmacy directors).

ZS derived 4 key conclusions from its survey:

• There is a clear lack of education concerning biosimilars across stakeholder groups. The survey found that, while most respondents said that they were either very knowledgeable or somewhat knowledgeable about biosimilars (92% oncologists, 100% payers, 93% pharmacy directors), many were less knowledgeable than they had reported. For example, 33% of pharmacy directors (and 24% of both oncologists and payers) believed biosimilars to be manufactured by chemical synthesis.
• Factors driving uptake of biosimilars are not limited to cost and reimbursement; comfort with a biosimilar’s manufacturer is key. Among oncologists, trust in the manufacturer was second only to cost benefit in the choice to prescribe one biosimilar versus another. Oncologists cited Amgen, Pfizer, and Boehringer Ingelheim as the brands whose products they would be most inclined to prescribe, and Dr Reddy’s Laboratories, Biocon, and Coherus as the brands whose biosimilars they would be least likely to prescribe. Payers and pharmacy directors, too, indicated strong brand preferences—payers indicated the greatest willingness to cover products manufactured by Teva and Sandoz, while pharmacy directors indicated the strongest preference for Pfizer. Payers said that they would be the least willing to cover Biocon’s products, and pharmacy directors reported their lowest levels of comfort with Samsung and Biocon.
• Approximately 49% of oncologists plan to adopt biosimilars, for all tumor types, immediately upon FDA approval. A further 18% will wait to prescribe biosimilars until key opinion leaders have verified safety and efficacy, while 21% will wait until peers verify safety and efficacy. If payers or practices force biosimilar adoption, the remaining 12% of oncologists reported that they would comply.
• There is a lack of consensus among oncologists on switching patients from the reference biologic to a biosimilar, but cost appears to be a critical factor in the decision-making process.

In reflecting on the challenges that lie ahead for biosimilars, Miller cited the need to drive down costs, but said that, until there are multiple biosimilars for individual reference products available in the marketplace, discounts for biosimilars will remain shallow. He also suggested that reference product manufacturers will do everything in their power to prevent the loss of market share for their products.

Yet biosimilars, said Corridon, still have the power to enhance value-driven care and increase competition. “Financial toxicity is real,” she said, and biosimilars could help ease financial burdens on patients.