Considerations for educating patients and providers on the role that biosimilars have in the treatment plan and their associated costs.
Al Heaton, BS, PharmD, RPh: Kyle, you mentioned that you spend a lot of time doing education amongst the providers and the patients. Can you give us an idea of exactly what you’re talking to them about? Should either one of those individuals be concerned about biosimilars?
Kyle Skiermont, PharmD: I think that’s probably the key piece of the education that we’re providing to our patients and to our providers is that, no, right? From the pharmacy department, if you will, or the pharmacy organization, and quite honestly, really, the science behind the biosimilars is that no, there is not a reason to be concerned with using these products.
Now that being said, we are also working with our providers and patients to do some things a little bit differently. In given areas we may be starting only new patients, as opposed to switching. So if we have a provider group that really has a concern about switching from a reference product to a biosimilar, or from one biosimilar to another biosimilar, we may give it, if you will, and say, “All right, let’s start it with new patients. Let’s get some experience using the biosimilar under our belt, as a health system or for a given provider.”
What we’re seeing is, as we do that, providers are pretty quickly saying, “OK, this is saving my patients money. I want to accelerate my transition of my patients. I want to do more than just new patients. I want to do some other things.”
One of the other areas, or maybe unintended things that we saw is that it also depends a little bit on the disease state. So, for example, if it’s something that’s readily measured, you know you have a concrete endpoint, we saw a biosimilar uptake in those areas much more quickly. I think as some more of the oncology products, the oncology biosimilars come to market, our oncologists are being a little bit more cautious, I’ll just say. Right?
For them I think the approach is, well it’s 99% the same, or 99.9999% the same. But what if I’ve got that 1 patient? And so, and I think we’ll always see that, right? I mean, historically with generics, even with Coumadin you had the cardiologist who said, “Yeah, but what if I’ve got that 1 patient for whom there’s a slight difference?” So I think the education definitely will continue. And I think the other potential challenge that we’re going to see to uptake is if a given reference product has a particular administration device, for example, or a different way to be administered. So for us, for example, 1 of the biosimilars is only available in a syringe and not through a vial. In our bone marrow transplant program, being in a vial and having very flexible dosing for a given patient was really important. So we’ve not seen great uptake there. Or I think some of the on-body devices, for example. Pushback may be too strong, but we’re seeing providers saying, “Hey, I think this is a better method to give this medication. I don’t necessarily want to have to switch back to a syringe if I’ve got the on-body device, or switch back to an injection,” for example.
Jonathan Ogurchak, PharmD, CSP: You bring up a good point as it relates to education related to providers and patients. There really shouldn’t be any concern as it relates to a component of the biosimilar drug, because when it is going through the application process there is a required callback to data associated with the FDA approved reference product. So it’s not like this product is just being reviewed and considered in a vacuum, there’s a precedent there. It’s looking at how that reference product was used in patients to gain approval. And it’s just a matter of determining, ongoing, how we can further empower pharmacists to practice at the top of their license to allow for interchangeability similar to how they practice right now in the generic space. If you think back to 30 years ago, there wasn’t a precedent for how generics were managed. We’re now seeing that in the biosimilar space as it relates to these specialty products.
Kyle Skiermont, PharmD: In a similar way we’re seeing some of those challenges with patients. And trying to help them understand why they may want a lower cost drug. Because no patient wants to be told, “You can have the Porsche or you can have the Chevy,” and be told, “You get the Chevy.” I think the reality though, what we’re seeing and where we’re at with education with patients is trying to help them understand that analogy really doesn’t make sense in this case, right? That we’re not saying to them, “We’d like you to accept a lesser level of care,” that in fact a lot of the education that we’re doing with patients is, “No, this is potentially an opportunity for you to get the same level of care, but at a much, much lower cost.” These biosimilars, in our perspective, are expanding the potential as to how far the healthcare dollar could go with these patients.
And trying to help them understand that these medications are safe and effective, and that these medications will give them the same results as what they would see with the reference product. So we’ve got the health plan backing it and potentially even driving or mandating it, but also having the provider on board. There is no bigger challenge for us to try to educate a patient or try to help a patient understand that this is a safe and effective treatment for them if their provider is pushing against that.
So in a weird way and different than in a lot of other areas, I think with biosimilars one of our strongest patient education advocacy programs, if you will, has really been with the providers as well. So definitely explaining it to patients, making sure that they understand it, but also making sure that the provider is on board and is helping to drive that message as well.