Part 2: Ivo Abraham, PhD, RN, Discusses the Pandemic’s Effect on Pegfilgrastim Biosimilar Use

To watch part 1 of this interview, click here.

The Center for Biosimilars® (CfB): I'm Tony Hagen, senior editor for The Center for Biosimilars®. Recently, we spoke with Ivo Abraham, PhD, RN, a professor with the University of Arizona Health Sciences in the Department of Pharmacy Practice. He is also a health care consultant with Matrix45, which he co-founded. In this part of the interview, Abraham discusses how the use of pegfilgrastim biosimilar is likely to be affected by the current spike in the COVID-19 [coronavirus disease 2019] pandemic.

As we enter the second significant wave of COVID and hospitalizations soar, it's important for patients with cancer to stay out of the hospital at all costs. What do you see happening with these pegfilgrastim dynamics during this phase of the pandemic?

Abraham: Well, as long as we're under pandemic conditions, it's going to be very difficult for biosimilar manufacturers to compete. And we're going to see a continuation of price erosion. On the ASP [average sale price], the challenge then goes back to what are the pathways that we should follow?

The thing we can learn from other parts of the world is whether [pegfilgrastim] necessarily needs to be administered in a cancer center. When my sister was recovering from breast cancer in Belgium, she could go to her GP (general practitioner) down the street in the village and get her injections. This was supervised by the cancer center. In other countries, home health nurses come in to do the rounds. And that is easy to implement in places where people live close together. You can have the home health nurse go without spending much time traveling. For patients who live farther away, [they can use an] on-body injector.

CfB: Although you can potentially save money from using pegfilgrastim biosimilars, as your studies project, is that money really available to providers to apply for the treatment for individual patients or are those savings really going to the payers, or to the manufacturers? Who really benefits from those savings?

Abraham: The direct beneficiary is a payer. [garbled] Taxes, employee contributions, employer contributions. Ultimately, the savings affect the payer and very indirectly affect those of us who contribute to the pool of money. That being said, the important aspect is that we need to put pressure on the payers to use that money, those savings, in a meaningful way.

Now, there's a challenge there because the private payers are publicly owned companies. So, for them, and I'm oversimplifying, it might be good to have better results or show cost reductions and all of those good things. Another element that is important in this regard, is that, for instance, CMS is experimenting with and implementing certain programs that financially incentivize the provider organizations. For instance, the Oncology Care Model. In the Oncology Care Model, one element is your drug budget and bringing that within certain parameters. So, when converting to a biosimilar, if there is a price difference, it helps you with that. There's a benefit for the provider organization in the sense that their drug budget goes down. As a provider with your savings, you should be using that in a responsible, ethical way, and you could say, "We're going to allocate some of those savings or all of those savings to patient-centric services or buy more drugs that otherwise we would not be able to buy."

What we're now beginning to elaborate on with ACCC [The Association of Community Cancer Centers] is how could that be used for patient-centric services? Patient-centric can be very simple [such as] transportation support, especially for long distances. It can be nutrition support. We do know that a lot of cancer patients are paying so much out of the household budget that there is a certain degree of food insecurity. It could be with financial navigation services. So, from a payer perspective, you could end up providing even better care to your patients and help them thorough one of the toughest periods in their lives. There is an enormous opportunity there, especially with incentive programs, for providers to benefit as well.