Biosimilar Pegfilgrastim Can Increase Access, but Patient Perception Remains a Biosimilar Barrier

Biosimilar pegfilgrastim, of which 2 brands (Mylan’s Fulphila and Coherus BioScience’s Udencya) have become available in the United States recently, is listed at discount of 33% to the reference product, Amgen’s Neulasta.

During the 2019 American Society of Clinical Oncology Annual Meeting (ASCO), researchers said that, for payers with large populations, the discounted biosimilar pegfilgrastim can produce substantial cost savings that can be applied to offer increased access to supportive care.

The research team, from biosimilar developer Sandoz, which is developing its own biosimilar pegfilgrastim, used a cost minimization model based on a hypothetical group of 20,000 patients.¹ They used the average selling price, obtained from payment allowance limits in the first quarter of 2019, for prophylaxis of febrile neutropenia for 1 chemotherapy cycle.

The simulation included a calculation of cost minimization per cycle when patients were converted from the reference pegfilgrastim to a biosimilar on a ratio of 10% to 100% and at a discount of 15% to 35%. Expanded access to biosimilar pegfilgrastim was calculated based on budget neutrality.

They found that per-cycle per-patient cost minimization of converting from reference pegfilgrastim to the biosimilar ranged from $702.27, representing a 15% discount, to $1638.63, representing a 35% discount. For the total 20,000 patients, these savings totaled more than $14 million at a 15% discount to $32 million at a 35% discount for a 100% conversion rate. If half of patients were prescribed the biosimilar, savings could range from more than $7 million at the 15% discount to more than 16 million at the 35% discount.

If 100% of patients were prescribed the biosimilar at the 15% discount, an additional 3529 patients could be treated with the savings generated. If half of the patients were prescribed the biosimilar, the savings could be applied to treat 1765 patients at the same discount. Assuming a 35% discount, 50% biosimilar use would produce savings that could allow 5385 patients to be treated.

For payers with sizable populations, say the researchers, biosimilar pegfilgrastim offers an opportunity to provide increased access on a budget-neutral basis.

While the budgetary benefits of biosimilar pegfilgrastim are clear from the payer perspective, patients may continue to have concerns about receiving a biosimilar rather than its reference. Also during the ASCO meeting, another research team published findings that, although a majority of patients with cancer do not believe that more costly drugs work better than cheaper alternatives, they may have residual concerns about cost-saving drugs when used in cancer care.²

The researchers surveyed a sample of 75 patients with cancer in clinics and an infusion center, asking questions about cost and patient participation in decision-making about treatment options. In total, 66% of respondents said that they did not believe that more costly medicines were more effective than less costly ones for the same disease. However, just 60% of that group and 44% of the overall group said that they preferred that their doctor prescribe a cheaper drug for them.

Among respondents who expressed a belief that more expensive drugs are not more effective but wanted to receive a more expensive drug anyway, 8 respondents indicated that they believed cancer to be too serious to take chances, 5 wanted the most expensive drug covered by insurance, and 2 said that they wanted the best possible medication available.

Additionally, 90.67% said that they wanted to be informed if their physician was prescribing a less expensive version of their therapy.

According to the authors, patients have lingering concerns that cost savings may be a proxy for quality, particularly in cancer indications. Overcoming these perceptions will be crucial, they indicate, if cost savings are to be possible.

References

1. Wang W, Balu S, Campbell K. Cost-minimization analysis for biosimilar pegfilgrastim in the prophylaxis of chemotherapy induced (Febrile) neutropenia and expanded access based on budget neutral basis. Presented at: the American Society of Clinical Oncology Annual Meeting 2019; May 31-June 4, 2019; Chicago, Illinois. Abstract 6645.

2. Harvey RD, McGrath M, Cook JW, Dixon MD, Pentz RD. How will the cost of biosimilars affect patients’ willingness to receive them? Presented at: the American Society of Clinical Oncology Annual Meeting 2019; May 31-June 4, 2019; Chicago, Illinois. Abstract e18338.