Part 1: NCCN Panel Discusses Patient Education on Biosimilars

Switching patients to biosimilars can sometimes be a difficult feat, given patient preferences, which may be determined only by what a patient may have heard about a biosimilar from an acquaintance, panelists said in a biosimilars discussion, “Role of Biosimilars in the Oncology Ecosystem,” at the National Comprehensive Cancer Network (NCCN) Virtual 2020 Annual Conference, May 15, 2020.

“We’ve seen a handful of patients who have outright refused conversion to a therapeutic biosimilar because of rumors or perceptions by other patients who have experience or have used the biosimiliar and have had worse adverse events in their opinion, or have not had a great experience,” said Drew S. Mace, PharmD, pharmacy supervisor at the Ann B. Barshinger Cancer Institute in Lancaster, Pennsylvania.

Studies have demonstrated strong patient concerns about switching. “That’s the patient conundrum that we’re trying to deal with, but ultimately, it is their decision, even as financially toxic as it may be for them. Some folks really don’t mind,” he said.

However, the advantage of a biosimilar is that it is a therapy that is therapeutically equivalent to an original drug and often offers the prospect of significant savings, panelists said. Further, a decade of experience with biosimilars in Europe suggests that there are no significant safety or efficacy concerns that ought to dissuade patients from choosing these agents, said Scott A. Soefje, PharmD, RPh, director of the Department of Pharmacy at Mayo Clinic in Rochester, Minnesota.

In incorporating biosimilars into its therapeutic plans, Mayo had to escape from the gravitational pull of innovator companies, who wanted the clinic to continue using its brands for their patients. “We had no incentive to switch away from them,” Soefje said.

That began to change as payers started demanding that biosimilars be used. “We’re happy that payers are coming back and saying we don’t care which biosimilar you use, just use a biosimilar.” Mayo has adjusted its electronic medical record system to give pharmacists more power to move preferred biosimilars into treatment regimens.

The experience at Barshinger has been similar, Mace said. Treatment plans have been “defaulted” to biosimilar agents. For patients who are initiating therapy, there’s really no reason for the provider to be heavily involved in the prescription choice of biosimilar over reference product. That said, “It becomes very complex when converting someone who was established on a reference product to a biosimilar. There’s a lot of education that needs to occur on the front end, both with the prescriber as well as the patient,” Mace said.

Patients often develop their own preferences for drugs from their participation in blogs and support groups, “so, unfortunately, as great as they are for all the social help that they provide for someone who’s undergoing cancer care, sometimes they’re an area where rumors or disinformation can actually spread,” he said.

The education component is difficult, as is managing the fears and concerns that patients have regarding converting from a reference product to a biosimilar, he said. Patients worry that “This is different. Its name is different, and therefore it must be a different or even an inferior drug.”

When it comes to patient conversions to biosimilars, Mayo doesn’t flatly refuse to allow the patient any choice, Soefje said. Patients can say no, that they don’t want the conversion, but if their payer happens to be demanding a biosimilar, the clinic has to be upfront with them and warn them that going with a reference product is going to result in additional cost.

Soefje said Mayo does try to put a limit on the number of switches within the spectrum of available reference and biosimilar products. “We won’t allow more than a single switch.”

Part II of this report can be found here.