番茄社区

LAS VEGAS -- Use of biosimilars for cancer care increased at a network of community oncology practices following the implementation of a pharmacist-led biosimilar substitution program, and cost savings followed, a researcher reported here.

For four of the five agents evaluated, use of "preferred" biosimilars increased from about 75-90% before implementation of the program to above 90% for all four by the end of the study period, according to Jenny Li, PharmD, a clinical pharmacy services manager at the American Oncology Network (AON) in Texas, who presented the data in a poster presentation at the Midyear American Society of Health-System Pharmacists meeting.

Looking at the period from April 2021 to April 2022, payers saved $19 million before the program's implementation in October 2021, and $34 million thereafter. Providers saved $38 million and $72 million for the two periods, respectively.

"If the hurdle of trying to establish a program is what's stopping [people] from considering biosimilars, then hopefully projects like this, real-world data like this, will help convince other folks that it is possible," Li told 番茄社区.

The program assigned regional clinical pharmacists (RCPs) to various geographical areas that AON serves, to work with 107 physicians and 85 advanced practitioners at 76 locations, mostly small or independent practices operating outside large hospital systems. The RCPs would act as a liaison between providers, payers, administrators, and financial advisors to facilitate switches where possible and when cost-effective.

AON-preferred biosimilars were automatically embedded into provider's drug treatment regimens via their electronic health record (EHR) system. The pharmacists, financial teams, and providers would coordinate via the EHR to ascertain if patients' insurers would still cover the biosimilar, that the provider and patient were satisfied with the switch, and that the patient would actually save money. Switches were ultimately confirmed with provider approval.

About 20 biosimilars for cancer treatment exist. The five biosimilars they followed were for bevacizumab (Avastin), trastuzumab (Herceptin), rituximab (Rituxan), filgrastim (Neupogen), and pegfilgrastim (Neulasta). At the start of implementation to study end, approximate use of the preferred biosimilars increased by the following:

• Bevacizumab: 92% to 96%
• Trastuzumab: 88% to 94%
• Rituximab: 82% to 94%
• Filgrastim: 77% to 92%
• Pegfilgrastim: 45% to 68%

According to the poster, non-preferred pegfilgrastim use remains high due to patient and provider preference of the on-body delivery system, especially in clinics that serve patients living in rural areas.

Li said that introducing the RCPs relieves some of the pressure on providers to juggle financial logistics in selecting drugs that work well for their patients.

"In the past, our providers [would] get anywhere between 10 to 40 calls from the financial counselors letting them know, 'Hey, Doc, your drug that you just prescribed for this patient? Well the payer doesn't cover it.'" Li said. "So now our pharmacists are taking the burden away from the provider."

According to surveys, healthcare providers still remain hesitant to substitute biosimilars for nonmedical reasons, due to uncertainty about the efficacy and safety versus the reference product, or because of concerns about the switch affecting the relationship with their patients, among other reasons.

Another motivation for the program was keeping cancer patients close to home. Sometimes, Li said, a patient's experience is "going to be driving 3 hours to an academic center, and they don't know anybody, and they have to stay overnight" for treatment, she said. "Our focus is, let's not take the patient out of something that they're familiar with. Keep them in the community and support them through it as much as possible."

This is easier with extra support, like the RCPs, she said. "Oftentimes in these types of practices, they might not have the resource of the pharmacist."

The program launched in October 2021, and cost savings for the study were evaluated from April 1, 2021 to April 1, 2022. Barriers to making switches to AON-preferred biosimilars included patient assistance and compassionate drug programs, patient or provider preferences, and payer-specific biosimilar selection requirements. AON paused tracking of patient savings because there were too many confounders.

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