Sonia T. Oskouei, PharmD, BCMAS, DPLA, vice president of Biosimilars at Cardinal Health, discusses motivating factors that affect use of biosimilars in oncology.
Oncology providers are, in general, highly sensitive to costs of biologics, so expanding payer coverage of these agents to include lower-cost options is likely to drive adoption of biosimilars in oncology, said Sonia T. Oskouei, PharmD, BCMAS, DPLA, vice president of Biosimilars at Cardinal Health.
“From our surveys we know that the top 2 reasons oncologists are likely to prescribe a biosimilar are if it provides costs savings to the patient or practice or if the insurance company mandates a switch,” Oskouei said at this year's Association of Community Cancer Centers (ACCC) 47th Annual Meeting & Cancer Center Business Summit. Her presentation covered motives and biases that influence the prescribing behavior of oncologists.
A 2017 Cardinal Health survey identified fear of monetary loss as the chief bias influencing physician decision making in oncology, with 23.9% of respondents in agreement. These same physicians identified a strong bias toward following established guidelines from such nationally recognized entities as the National Comprehensive Cancer Network and the American Society of Clinical Oncology (22.0%). Lack of clinical response and the predictability of outcomes were 2 other factors that oncologists identified (16.5%) as influencing their likelihood to prescribe biosimilars.
"A Consistent Theme"
“The responses really haven’t changed that much since 2017. This is a consistent theme when it comes to biosimilar utilization—the correlation to cost savings,” Oskouei said.
Whereas physicians may gravitate toward biosimilar use to save money, value-based care programs, such as alternative payment models (Oncology Care Model, Oncology Care First, Merit-based Incentive Payment System) are accelerating that trend, she said. “Biosimilars are really valuable tools for providers practicing in the value-based care initiative. These are ways to allow cost savings and efficiencies in delivering high-value cancer care and expanding the use of biologic treatment.”
In fact, loss aversion is a very powerful motivator in the oncology sector. Asked in 2017 how often fear of not being reimbursed influences their prescribing habits, 37.1% of oncologists answered “very often," and 25.8%, “moderately often.”
“The fear of monetary loss has double the impact of any potential equivalent gains, studies have shown, so it makes sense that this would be a primary driver of potential bias,” Oskouei said.
Familiarity with biosimilars plays a large role in acceptance and use, she said. Oncologists were first introduced to biosimilars via supportive care products, which as indirect treatments for cancer present a lower-stakes risk for oncologists. Their positive experience with these products may have contributed to their acceptance of therapeutic oncology biosimilars, she said.
However, familiarity also may mean a dependence on peer experience with and willingness to adopt biosimilars. For example, in a 2017 survey, 64% of oncologists agreed that they expected to be early adopters of biosimilars, but 33% said they would wait for other academic and community leaders to adopt biosimilars before prescribing them themselves, and the remaining 4% said they would not use biosimilars unless mandated to do so by payers.
“They’re trying to develop that familiarity and see peers utilize biosimilars and build more confidence in the outcomes before adopting,” Oskouei said.
Oncologists’ confidence in biosimilars may be biased by the statements about them written by the FDA and other authorities, she added. For example, the statement “Biosimilars are not inferior to reference products in terms of safety and efficacy” is less convincing than “Biosimilars are as safe and effective as the reference products."
Indeed, the FDA has considered rephrasing biosimilar language to get around the bias that such cautious language induces.
Differences in the language used to present biosimilar is known as “framing,” and these differences have the potential to influence decisions about the use of these agents, Oskouei said.
“A lot of educational efforts and programs have helped address the potential framing bias with biosimilars,” which has turned up in literature from not only the FDA but also health care industry sources, she said.
When it comes to biosimilar uptake, a lot depends on physician education, but other agents and drug developments also play a role. Originator manufacturers are continuously innovating, developing new formulations of existing treatments, new methods of delivery, and also new medicinal products entirely, Oskouei said.
“We can’t just look at the originator biologic and the biosimilars in silo when making treatment decisions, because there are continued advancements and novel dosage forms that can compete with biosimilar utilization. Conversely, there’s also the discussion around obsolescence when it comes to biosimilars and their originator biologics,” she said. “The key message is that it’s really going to continue to be a very dynamic market.”
Oskouei ST. Biosimilar adoption in oncology: how attitudes have changed and what’s ahead? Presented at: ACCC 47th Annual Meeting & Cancer Center Business Summit; March 1-5, 2021. Accessed March 5, 2021. https://www.accc-cancer.org/home/attend/accc-47th-annual-meeting-cancer-center-business-summit/agenda#undefined5