Institutions Report Shift to Oncology Biosimilars in Pair of ASCO Abstracts

Practices and health systems are increasingly looking at biosimilars as a way to reduce costs and improve access to treatments. The oncology space has been a huge success for biosimilars in the United States with a majority of FDA-approved biosimilars with oncology indications and the strongest adoption.

At the 2022 annual meeting of the American Society of Clinical Oncology, 2 abstracts looked at biosimilar adoption in oncology. The first abstract reviewed the approach from Cedars-Sinai Medical Center to standardize biosimilar utilization across the oncology enterprise.¹

The standardization process included integrating clinical algorithm pathways and financial information in the electronic health record and implementing preferred biosimilar drugs as selected by the oncology Pharmacy & Therapeutics committee. Physicians were able to opt out of substitution, and the authors compared compliance rates at the main medical center and the affiliated sites.

They identified 535 patients with cancer who initiated treatment with bevacizumab, rituximab, or trastuzumab between January and December 2021 who were eligible for the analysis. These patients were between the ages of 18 and 96 years and 61% were female. Prior to the new process, the biosimilar substitution rate was 55%, which increased to 83% after the new process. The substitution rate ranged from 76% to 97%.

As expected, the conversion rate was higher at the main medical center (85%) compared with the affiliated sites (81%). A total of 92 patients (17%) did not have a substitution to biosimilars and the most common reasons were:

• Off-label indication (35%)
• Patient assistance program (17%)
• Payer preference (15%)
• Clinician preference (12%)

Rituximab had the highest conversion at the main medical center (92% vs 91% for trastuzumab and 76% for bevacizumab). There were 3 affiliated sites. At site 1, trastuzumab had the highest conversion (91%). At site 2, rituximab had the highest conversion (90%). At site 3, trastuzumab had the highest conversion (80%). Site 3 had some of the lowest conversion rates with the bevacizumab rate only 33%.

Overall, the authors estimated a $1.2 million reduction in direct spending per month for an average cost savings of 23% based on the wholesale acquisition cost.

“This real-world data suggest use of an integrated electronic health record to standardize biosimilar utilization in oncology and reduce costs,” they concluded. “This approach leverages existing infrastructure for successful biosimilar adoption in oncology while preserving quality and safety.”

In the second abstract, researchers at the Roswell Park Comprehensive Cancer Institute in Buffalo, New York, used a 40-question survey to gather information about biosimilar use in order to describe the current state of biosimilars in oncology practices and barriers to adoption.²

The survey evaluated formulary management, product usage, policies, technology, safety, and education for bevacizumab, filgrastim, epoetin alfa, infliximab, pegfilgrastim, rituximab, and trastuzumab. A total of 179 surveys were initiated by members of the Hematology/Oncology Pharmacy Association. Ultimately, there were 50 unique surveys completed, 21 of which were from National Cancer Institute–designated comprehensive cancer centers.

In the inpatient setting, formulary decisions were driven first by acquisition cost, but in the outpatient setting, these decisions were driven equally by acquisition cost and reimbursement.

According to the surveys:

1. 32% of institutions restricted biosimilars to their FDA-approved indication
2. 66% had an interchangeability policy
3. More than 90% had a preferred biosimilar on formulary

A majority (72%) stated payers specified the selection of biosimilars and 76% said payer reimbursement limited their ability to participate in contract pricing.

Filgrastim had the highest average utilization (88%), followed by epoetin alfa (82%). Pegfilgrastim had the lowest average utilization (52%) followed by infliximab (57%).

The most common barrier to biosimilar adoption was insurance coverage (82%) followed distantly by drug availability and computerized provider order entry (both 24%).

Overall, the researchers noted that the responding institutions had a utilization shift toward biosimilars compared with reference products and that adoption was consistent across institutions.

“Opportunities exist in the collaboration of health systems and payors to align formularies and promote safe and cost-effective care for their members,” they concluded.

References

1. Limvorasak W, Leung Dobbs C, Kim J, et al. Successful biosimilar adoption in oncology: strategic approach to system standardization. Presented at: ASCO 2022; June 3-7, 2022; Chicago, Illinois. Abstract e18605.

2. Reed M, Przespolewski E, Doughty Walsh M, et al. Survey of biosimilar adoption across oncology pharmacy practices. Presented at: ASCO 2022; June 3-7, 2022; Chicago, Illinois. Abstract e18813.