Biosimilars and Pharmacy Interchangeability - Episode 2
Progress of Biosimilars and Personal Experience
Experts consider the progress surrounding biosimilars in health care and share personal experiences.
Kyle Skiermont, PharmD: So my experience with biosimilars has really changed over the last couple of months here—more entrants have come into the marketplace and more physicians are either choosing to use them or, from exterior plan design, are being, I’ll say, forced.
Al Heaton, BS, PharmD, RPh: Somewhat forced?
Kyle Skiermont, PharmD: I’ll say forced, yeah. Or somewhat forced to use them. I think the experience is definitely rising here relatively rapidly. And I think what we’ve experienced in our health system is that as people have changed, we really aren’t seeing any issues with it. So we’ve tried to roll things out in different disease states differently, based on physician preference, but in some cases we’ve used it only for new patients, or we’ve had providers request that we use it only for a new patient. With others, though, we have had some successful switches.
I think we’ve also seen that it depends a little bit on what the product is being used for, right? So I think if you look at some of the filgrastim products, for example, it’s an acute need. You’ve got a relatively reasonable end point that you can measure. The providers were very, very comfortable with that. As you move into some of the other products, for which it’s a little bit less cut-and-dried or black-and-white what the outcome will be, there is a little more hesitation. But as we’ve pointed to some of the data in both the United States and Europe, I think we’re really starting to see the physicians become more and more comfortable in using the products.
Al Heaton, BS, PharmD, RPh: Yeah, and I would agree with that. We have a couple of early adopters, in terms of rheumatologists or gastroenterologists. But the pace was much slower than what we anticipated. But we’re seeing the European data coming out now where they have 60%, 80% of the market share, and particularly in the Scandinavian countries. And we have physicians, and we actually now are getting members asking, “Well, how come not here?” I mean, we’ve built this, and nobody is coming. That is what the scenario looks like. And it does result in lower cost.
The buy-and-bill methodology that most of the drugs are delivered on doesn’t lend itself much to, say, a pharmacist involvement. Certainly, it’s outside of that. And I think when the FDA approves interchangeability for the pharmacist, that will really speed the process. Because right now it’s totally separate, and it’s under the purview of the provider.
Kyle Skiermont, PharmD: You hit on something that we were surprised by as well, that we didn’t see the uptake. I think a lot of us thought that as soon as they hit the market we were going to see 20%, 30%, 50% market share swings to the biosimilars, and we just really didn’t see that. But what we are seeing, in particular, as you mentioned, is that some of these are billed more on the PBM [pharmacy benefit manager] or on the pharmacy side. And we are seeing pretty dramatic moves, at least from certain payers, in which we’re moving essentially all those patients to a biosimilar.
In our experience, what we’ve seen and what our pharmacists have been trying to do as much as possible is write in collaborative practice agreements, or write in agreements with physicians, so some of those changes can be made—on the fly might be a little bit, you know, too much, or I might be selling it too much to say that it’s that easy. But trying to put the things in place, whether it is again with order sets or with, I’ll call it automatic substitutions, but more so working with providers to even have them write for—you know, instead of a trade name, having them write for, and again, with biologics, we have to be careful calling it the generic name. But essentially the generic name, such that we can use 1 that will be the most beneficial from a cost perspective for the patient.
Al Heaton, BS, PharmD, RPh: Right. And we’ve seen that the quickest uptake is in those—I would call them oncology support products. You know, the filgrastims, the white blood cell reports. I assume that when we see erythropoietins come out, we’ll see the same thing, because it’s not the oncology drug; it’s ancillary. Oftentimes those are left to the discretion of the pharmacist to fill those orders. We have talked to the oncology pharmacists in a lot of our big health care systems, and they determined that. So there was that fairly quick uptake right there, and now we’re just trying to capitalize on that.
Kyle Skiermont, PharmD: And you mentioned kind of the difference between the buy and bill in the pharmacy side. I think, for us, we’ve actually almost seen it easier to make the change on that clinic side, because you know there have been things such as IVIG [intravenous immunoglobulin], for example—where inside a health system, you know we were probably using 1 manufacturer, unless there was a real reason to use 1 of the others. And most of the time the order was being written, IVIG—you know, the pharmacy to select the product or pharmacy to dose, those types of things. We’re starting to see that with some of the products that have 1 or even 2 biosimilar options now as well.
Al Heaton, BS, PharmD, RPh: And we’ve done the same thing in our P&T committees, where we’ve talked about therapeutic equivalence. We see no difference in the outcome. IVIG is a very good example of that. We have a dozen products. Let’s pick the most cost efficient one for us.