Biosimilars have the potential to create a more sustainable healthcare environment by offering substantial cost-savings and expanding patient access to lifesaving therapies. At the American Society of Clinical Oncology 2021 virtual annual meeting, Lalan S. Wilfong, MD, Executive Vice President, Value-Based Care and Quality Programs, and Medical Oncologist/Hematologist, Texas Oncology, Presbyterian Cancer Center Dallas, TX, discussed how a community practice model for therapeutic interchange of brand drugs to biosimilars led to a significant increase in utilization of biosimilars and substantial cost-savings over the course of a single year at his institution.
“Biosimilar conversion can be rapidly accomplished via a physician-approved, pharmacist-driven, care-team approach,” he said. “The biosimilar therapeutic interchange processes we have implemented have significant implications for total cost of care and success in our value-based care models.”
According to Dr Wilfong, utilization of biologics is the dominant trend in oncology, accounting for approximately 70% of spending growth.
“Biologics have dramatically altered the care that we provide for our patients, but these drugs are expensive, and controlling total cost of care requires managing the cost of biologics for our value-based programs to succeed,” he said.
Biosimilars, which have been shown to be therapeutically equivalent to brand drugs at much lower costs, offer a solution for achieving substantial cost-savings without sacrificing quality. According to Dr Wilfong, however, therapeutic interchange is complicated by the designation of each biosimilar, which prevents simple substitution.
“Generic drugs can be substituted by a pharmacist without any approval at all because they’re designated generics,” he explained. “The way biosimilars are designated, however, requires both physician approval and patient re-consent for the therapy interchange to occur.”
Recognizing the importance of biosimilar substitution to reduce cost, Texas Oncology elected to increase utilization of biosimilars in 2020. Dr Wilfong and colleagues collaborated with McKesson Specialty Health to create educational materials for patients and clinical staff and communicated to all personnel regarding the therapeutic interchange process.
“A central pharmacy team reviewed all new orders and substituted a biosimilar for brand, unless a payer insisted on an origin drug or biosimilar not in the practice formulary,” said Dr Wilfong. “A weekly spreadsheet of all existing patients who would benefit from switching was also generated, and the pharmacy team, based on the indication and payer, would determine if a patient was eligible for therapeutic interchange.”
Following a consultation with the physician, the pharmacist substituted the biosimilar, if it was available. Patients were then educated and re-consented.
After starting with rituximab (Rituxan), Texas Oncology soon added bevacizumab (Avastin) and trastuzumab (Herceptin) to the initiative. Using a comprehensive team approach, Dr Wilfong and colleagues increased the utilization of rituximab from 5% in January 2020 to 80% in December 2020. Utilization of bevacizumab also increased from 9% to 88%, whereas trastuzumab increased from 8% to 74%.
“For just these 3 drugs, we’ve surpassed 85% biosimilar usage in our practice,” said Dr Wilfong. “We’re not at 100%, however, because many payers still require brand-name drugs for various reasons.”
Estimated cost-savings per dose-based average sales price were $550, $850, and $1400 for bevacizumab, trastuzumab, and rituximab, respectively.
“In 1 month alone, the project dramatically reduced cost by 21% ($4 million) by conversion to these 3 biosimilars,” said Dr Wilfong, who noted that additional savings can be realized with the use of biosimilar multidose vials versus single-dose vials. “This is very important to our practice because we are heavily involved in value-based care models.”
Dr Wilfong underscored the multidisciplinary effort needed to successfully deploy the therapeutic interchange of biosimilars for brand drugs.
“This initiative requires the entire care team to be involved because of the difficulty in simply converting patients to biosimilars,” he said. “The drugs have to be substituted, the physician needs to approve, and patients need to be educated and re-consented.”
“It’s a challenge at first, but this comprehensive team approach has real implications in controlling the total cost of care,” he added.
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