The Biosimilar Solution to Expensive Cancer Care

In a recent column in Evidence-Based Oncology^™, a sister publication to The American Journal of Managed Care^®, Kathy Oubre, MS, chief operating officer of Pontchartrain Cancer Center in Louisiana, decried the refusal of many insurance payers to add oncology biosimilars to their drug formularies. The cost is steep, she claimed: Patient health is at stake.

The costs of cancer care today have far-reaching implications, with the effects of the high prices of biologic medications inserting themselves in all facets of patient life. Patients often do not fill critically needed prescriptions, bypass important diagnostic tests altogether, or fail to even make appointments to see their healthcare providers, Oubre pointed out. But there are solutions that enable easier access to care.

In May 2019, the FDA released its final guidance on biosimilars. These lower-cost alternatives are interchangeable to reference biologics because they “can be expected to produce the same clinical result as the reference product in any given patient.” And healthcare providers, and their patients, should have ready access to this more affordable treatment option.

Instead, biologic originator medications continue to be preferentially prescribed, often due to “anticompetitive rebating practices,” Oubre noted. “Where biosimilars, which are certified as clinically equivalent by the FDA, are the correct treatment option, failure to prescribe them is a failure to address financial toxicity.” This toxicity amounted to an almost 75% increase in 2018 net spending on biologics.

These “fail-first” policies amount to insurers effectively eliminating the lower-cost biosimilars as a treatment option for patients to choose over their more expensive originator biologics. And manufacturers are using questionable rebating practices to force this choice. Last summer, the Federal Trade Commission opened an investigation into the contracting practices of Johnson & Johnson’s for infliximab originator, and auto-immune drug, Remicade.

Despite claims that rebates benefit their insured populations as a whole, insurers avoiding the competition of biosimilars by not even providing them as an option does nothing to stem long-term price growth. And with more and more oncology biosimilars entering the market, healthcare providers should be able to help their patients reduce their out-of-pockets costs while providing the highest-quality care available, which will lead to savings over time. It’s simply a matter of being able to provide the choice, she wrote.

With the FDA’s updated guidance allowing pharmacists to substitute biosimilars for originator biologics, as they can for small-molecule generics and their brand name counterparts, progress is being made. In October, UnitedHealthcare even added biosimilar bevacizumab (Mvasi) and biosimilar trastuzumab (Kanjinti) to its lists of preferred products for commercial and community plans. But much remains to be done.

“The oncology provider community should demand better, making clear that antibiosimilar formulary policies infringe on providers’ ability to offer care in a manner that promotes the best outcomes for our patients,” Oubre emphasized. “Biosimilars may hold the key to savings for patients struggling with financial toxicity.”