Insight related to the potential impact of the adoption of multiple biosimilars into the US marketplace.
Al Heaton, BS, PharmD, RPh: Kyle, you mentioned that from the pharmacy provider perspective you have to stock basically everything that’s out there. At some point in the future, that might get to be 15, 20 drugs instead of 1. Looking ahead a little bit and realizing that we’re just on the cusp of biosimilars in the US marketplace, what do you see evolving with time?
Kyle Skiermont, PharmD: I think as more and more get approved, and as the uptake continues to increase, I see and what I hope to see happen is that it will snowball a little bit. We know that we’ve got at least 1 product now, maybe 2 products, where there’s multiple, and you’ve got 3 in the marketplace, and that’s driving a completely different market than what we saw when the first hit. So we’re seeing lower prices. We’re seeing, I think more importantly, more uptake of the biosimilars. As more and more come to market, I think it will become natural to move to these biosimilars. You and I probably won’t be having as many discussions around biosimilars, or, again, at least that’s my hope. A number of years from now, I hope that it has become the norm.
Al Heaton, BS, PharmD, RPh: Acceptance, right.
Kyle Skiermont, PharmD: It looks more like, yes, the brand name to generics. Even I know that as generics first came to the marketplace, it was similar. The thought was that nobody was 100% sure about this whole new marketplace and if it was really the same thing. I think we’re seeing a repeat of that with biosimilars today. And so, I think as more come to the marketplace, as it becomes more widely accepted, and as we get just more experience and more patient days with them…. The European market, if I remember right, in one of the classes has millions of days of patient therapy with no difference.
I think as we start to see that in the US marketplace, that’s only going to accelerate the continued use. And, as I said, I hope the continued competition in the marketplace will drive the manufacturers to have more and more entries. I’ve used the snowballing reference whereas the uptake goes up, there’s more reason for manufacturers to get into the space, and those just continue to build on one another.
Al Heaton, BS, PharmD, RPh: I’ve been in practice long enough to predate our state substation law, which is scary in itself. And I agree with how you said brand versus generic and the natural fear and uncertainty, but in our environment right now over 90% of our scripts are filled generically. So we’ve gone beyond that. It’s accepted. It is, for what it is, a very cost-efficient delivery of care. We’re able to treat 10 times the number of patients, for example, with depression than we could with branded products for the same cost. And my hope is in the future we’ll see something very similar with biosimilars.
Jonathan Ogurchak, PharmD, CSP: You bring up a good point as it relates to stocking multiple biosimilars on the shelves. Now fortunately most wholesalers, through whom these drugs are
purchased, allow for rapid fulfillment to that dispensing pharmacy. So it allows you to minimize keeping that drug on the shelf and allows for more just-in-time acquisition of that product. Now for a first fill that might prove problematic, but over time there’s the better understanding of what plan utilization may look like on a patient-by-patient basis, and what that need might look like within your patient population too. Pharmacies are better able to anticipate purchase requirements more appropriately, and so it allows for them to purchase a drug that’s going to be used for those independent biologics and biosimilars for patient utilization.