Biosimilar Acceptance Takes Time but Policy Intervention Is Needed, Panelists Say

Panelists at Asembia 2023 championed greater involvement of specialty pharmacists, payers, and providers in efforts to improve biosimilar acceptance and advocate for biosimilar policy changes.

The panel discussion took place during a session entitled “The 2nd Wave of Biosimilars: What It Could Mean for Specialty Pharmacy Today and Tomorrow,” and covered the ways biosimilars education is still lacking, how the oncology experience compares with other disease states, and whether the best of biosimilars is truly yet to come.

The speakers began with the distinction between the pharmacy benefit vs medical benefit spaces, saying that they have different incentives and considerations as well as different stakeholders driving biosimilar adoption (pharmacists vs physicians, respectively). Additionally, the hassle factor of reimbursements influencing prescriber decisions should be removed from the specialty pharmacy sector.

Education needs have changed over time. New specialties having biosimilar access means that sometimes education efforts have to start from scratch, and some providers in well-established spaces are still expressing concerns about biosimilar efficacy, suggesting that companies will have to work harder to convince providers to prescribe biosimilars. More education materials surrounding managing biosimilars in a clinic or pharmacy are also needed.

“Proving biosimilarity is harder than then getting approval for a novel therapy in some ways, because you have to be exactly like it,” said Fran Gregory, PharmD, vice president of emerging therapies at Cardinal Health. "You can't be different; you can't be better. So, the fact that efficacy is still questioned and challenged, to me, is a huge barrier that we still have to overcome after all these years."

The speakers compared the experience in the oncology space with other disease states, saying that although there was hesitation to use biosimilars at first, because oncologists don’t deal with chronic conditions and have had the most experience with biosimilars, they have a good clinical nature to adapt and accept these products.

Chrys Kokino, president of US BioPharma at Accord BioPharma, talked about how companies need to speak up about biosimilars to rheumatologists and ophthalmologists, because if those stakeholders had been engaged from the start, they might have been more accepting of biosimilars than they are currently.

"I think one of the issues, holistically, with biosimilars here in this country is that we tried to address everything all at once. Perhaps that was not the right strategy," Kokino said. "Perhaps what we should have done is go segment by segment, physician specialty by physician specialty, and hope that the effect that would have permeated out to all of those positions vs having attacked all at once which, of course, [at the time of the first biosimilar] was just the oncologists."

In addition to the Inflation Reduction Act, Gregory noted that policies that do not directly address biosimilars can still impact them. However, it’s important to know that the US health care system will require a lot of work and policy change to get biosimilar to patients at an affordable price.

“The US health care system is in the situation it's in because…we can't change it overnight,” she said. "And I spent years on the payer/[pharmacy benefit manager] side, and I get the pull to that bigger rebate. I get the pull to those dollars and cents. But I also think that we are going to start seeing people working together to get to the bigger picture. We all want to see cost savings to create a sustainable US health care system."

Sonia Oskouei, vice president of biosimilars and specialty at Sandoz, warned that continued lack of market competition could impact the sustainability of the market. She also recommended for stakeholders to raise their voices and advocate for policy changes at the local, state, and federal levels.

"If we don't have healthy competition in the market, which biosimilar companies are going to continue investing millions of dollars to bring these complex biologics to market?....It's a huge challenge and it's so policy driven," Oskouei said. "It takes time, but we need to plant the seeds every day to make the change….Each of you have a role and a voice. And the more voices we have around this, the more powerful it gets."