International Presenters Share Tips on Beefing Up Biosimilar Use

The United States could learn a lot from other countries about what policies can be successful at improving biosimilar utilization, according to presenters at the DIA 2020 Biosimilars Conference, who offered insight into what other countries have done to grow biosimilar use.

Presenters from Canada, the United Kingdom, and France discussed the steps each country took to foster clinical use and experience with biosimilars, the results, and any plans that are currently in the works to continue that growth.

Canada’s Oncology Biosimilars Initiative

Although switching policies vary from province to province, the pan-Canadian Oncology Biosimilars Initiative (PCOBI) was established to drive uptake of oncology biosimilars across Canada, according to Scott Gavura, a presenter and director of Provincial Drug Reimbursement Programs for Ontario Health at Cancer Care Ontario in Toronto, Canada.

Gavura said that Canada began to push for increased adoption of oncology biosimilars before attempting to do the same with nononcology biosimilars, because oncology biologics, in contrast to nononcology biologics, are typically administered in public hospitals or cancer centers for only a fixed duration of time and are generally fully funded by the government.

A 12-month action plan from the PCOBI established working groups for education and clinical operations that were tasked with developing standardized education resources for patients and clinicians and recommendations to help hospitals and cancer centers prepare for biosimilar implementation.

In Ontario, patients who were already being administered the reference product would be allowed to stay on that product; however, newly started patients would automatically receive one of the province's chosen biosimilars.

As a result, the use of bevacizumab biosimilars overtook the use of the reference product in about 7 months as use increased for the biosimilar and decreased for the reference product. Gavura said he expects this trend to continue over time.

The United Kingdom’s More Competitive Strategy

The United Kingdom’s National Health Service (NHS) took a different approach than Canada, in that their plan included oncology and nononcology biosimilars and allowed the reference product to compete alongside its biosimilar competitors, according to presenter Blake Dark, Commercial Medicines director for the NHS.

Dark explained that the NHS has a goal to have an adoption rate for the “best-valued biologic,” whether a biosimilar or the reference product, of 80% of existing patients within the first year on the market and 90% of new patients within 3 months. He said the program uses a “winner-takes- all” method, similar to that of tender systems, where the best-valued biologic would be the only product used.

The NHS implemented the program by first applying it to rituximab and trastuzumab products before expanding it to include adalimumab molecules.

As a result, national uptake of the best-value biologic for adalimumab reached 85.7%, varying by region. Some regions in England took a longer time to adopt the best-value biologic, which Dark said was likely due to the method of education used for the product (eg, whether it was delivered in a phone call or email as opposed to an in-person conversation with a physician).

“In the first year, we saved well over [$388 million],” Dark said.

France’s Incentives Experiment

Despite Europe’s biosimilar industry having a 10-year head start on the United States, biosimilar market penetration in France was low in 2018, with biosimilars obtaining just a roughly 10% share of the market after the first year, according to Etienne Nédellec, PharmD, a presenter from the French National Health Care Directorate for the Ministry of Social Affairs and Health in Paris.

Nédellec said that France set a target for the penetration rate to reach 80% in 2022 for all biosimilars, starting with adalimumab, etanercept, and insulin glargine molecules.

To do this, Nédellec said, France experimented by encouraging hospitals whose prescriptions are distributed by outpatient facilities, such as community pharmacies, to use biosimilars by offering a 30% share of the savings produced as a result of prescribing biosimilars. The incentive would be paid directly to the care unit rather than the hospital.

A second incentive of 20% of the savings was designed for the control group, which covered all other hospitals, such as those that provide surgery, obstetric care, or medical activities. These incentives would be paid to the hospital.

As a result of hospital incentives, Nédellec said, penetration rates for adalimumab jumped 20% in the first year for the experimental group vs 15% in the control group. For insulin glargine, penetration rates grew 10% for the experimental group vs 7% for the control group.