Will Gatziolis Talks Biosimilar Marketing in a Post-COVID-19 World

Will Gatziolis, MBA, an associate principal at ZS.

The Center for Biosimilars®: Hello, I'm Matthew Gavidia. Today on MJH Life Sciences News Network, The Center for Biosimilars® is pleased to welcome Will Gatziolis, an associate principal at ZS and an expert on biosimilar marketing. So, can you just introduce yourself and tell us a little bit about your work?

Gatziolis: Absolutely, Matt. Great to be here and thanks for the invitation! ZS is a professional services firm that prides itself on working side-by-side with its companies and its clients to develop and deliver products for them. My work is primarily focusing in the commercialization area and I've worked a great deal with biosimilar companies as they've been thinking through those issues. I've been with ZS for about 15 years and the organization has about 7000 [employees] at this point. It's been around for over 35 years and we've got 25 offices around the world.

CfB: So how is COVID-19 impacting the sales dynamic in biosimilar promotions?

Gatziolis: Biosimilar companies have 2 main actors that they're working with and to get in front of: the HCPs [health care practitioners] and then decision makers in different organizations (payers, hospitals, and other buying organizations). It is much harder to get in front of HCPs based on the COVID-19 situation. They are working hard on the front lines, and that's where they're supposed to be. We're thankful for those efforts. The challenge of getting in front of hospital decision makers and other buyers is a little bit less difficult because the conversations that biosimilar companies need to have with them actually lend themselves to a Zoom meeting like we're having today. Getting and having those discussions are ones that those decision makers [are very] open to. There are lots of challenges for them in terms of revenue generation in the hospital setting. Just this week, unfortunately, 400 employees were furloughed at the Detroit Medical Center, as an example. Those types of revenue challenges, [where] different parts of the hospitals are under capacity because patients are not coming in, creates a tension there for them to look at the opportunities to bring biosimilar assets into their organizations. With the multiple launches we've had of oncology biosimilars, the theory is that there's a lot of those kind of discussions happening. And because these are able to happen in this way, and the desire from those hospital decision makers to stretch those budgets and think about what the rest of 2020 looks like, we believe that those conversations are happening more than maybe they would have happened prior to this.

CfB: So, to go off that, is the situation simply going to extend reference product dominance because biosimilar companies can't get the word out?

Gatziolis: I don't think so. We've already seen upward of 18% to 22% market share erosion in the oncology [monoclonal antibodies; mAbs] that have launched since July. In both the Avastin [bevacizumab] marketplaces and Herceptin [trastuzumab] marketplaces, we're seeing that kind of erosion. I suspect we're going to continue to see those types of erosion opportunities happening because of those budget pressures and the need to bring those products in. If you separate the 2 problems between the oncology marketplace and inflammation marketplace, patients with cancer still are needing to be treated, though there are signs that there are fewer patients getting started on drugs based on the fact that fewer of them are coming to the doctors. We are expecting to see that kind of erosion continue. And those conversations, like I was just mentioning, are going to continue as well. With all the launch activity that's still existing in oncology marketplaces, the expectation is that over time, those 20% could get closer to what we started to see in the supportive oncology marketplaces and move [them] further along.

CfB: What biosimilar products and launches have been most affected or are likely to be affected by COVID-19?

Gatziolis: So, I mentioned before that we had 2 products launches in early or middle of 2019. Since that time, we've had 10 or so products either approved or get launched for those 3 molecules plus a couple of supportive care molecules. Those products are experiencing different market situations than they would have had before. They've had to change up how their business model is working the same way many different businesses have. Think about restaurants and educators and all sorts of people have had to turn to digital channels in order to get their message out and to communicate with their customers. The same thing is true of the biosimilar manufacturers, as it is for all the pharmaceutical companies. Those types of impacts are there and but [manufacturers are] able to move quickly and make those changes happen because the conversations that they need to be having can happen over these types of communication vehicles. The expectation is that hospital decision makers and payers are open to having those discussions. So, the thinking is that while they're affected, they may not actually have a real long-term market effect in terms of the transition to the marketplace from the reference products to the biosimilar companies.

CfB: What is the mood now in biosimilar companies with developing products or ambitions to get FDA approval or get to the market soon?

Gatziolis: There are products that are expected to launch in the rest of 2020. There are some supportive care oncology assets. There are some other assets that are going to come into the infliximab market. So, the belief is that those are going to continue to move forward. There's nothing that we've seen in our view of the marketplaces that’s going to say there's going to be a change there. Just today, we heard from Momenta and Mylan that they're planning on introducing an Eylea [aflibercept] biosimilar in the US by 2023. So, there's still activity in the pipelines as well as organizations are thinking about the next wave of assets. I think what's going to be really important, and where this is becoming a very interesting discussion about the overall COVID-19 effect is [that] 2020 was about the setting up a long-term, fundamental marketplace for oncology biosimilars. The effects of COVID-19 are going to be interesting to see if that marketplace does develop faster than we would have expected. Is it going to hold in a place where biosimilar manufacturers look at [it] and say, “Yes, there's a very viable marketplace opportunity for me for the second and third wave of assets that are going to come over the next 5 years”? That's the kind of conversation that ZS is having and thinking about as well with this marketplace.

CfB: What can smart biosimilar companies do to get through the crisis? Just hunker down?

Gatziolis: I think it's an opportunity for them to think a little bit about how they're marketing their products and the messages they're sending to their customers. Thinking about their customer needs deeply and finding out what's exactly relevant to them right now, will help them long term as they communicate to their customers. So, hunkering down is important and, obviously, thinking about what to do with their field forces today that are not active and using those opportunities to train and think about different ways to contract with their customers. But most importantly, it's about how can we be relevant and what customer needs are there right now that we can answer and address moving forward?

CfB: So, when we emerge from all of this, how different is the biosimilar marketing landscape going to look from what it is now?

Gatziolis: I think the biosimilar landscape is going to look very similar to the pharmaceutical landscape. I think a lot of us are trying to figure out what that's going to be and are looking through a magic 8 ball to understand what some of these changes are going to end up being. I think the move that telehealth is having and some of the successes [it has had] are really important and there's going to be some change to see more telehealth. But, there's also just the instance of physicians: Are they willing and able to prescribe to patients that haven't had biosmilars before? I think with the products we're talking about, these complex mAbs, in very serious patient situations, doctors are going to want to see them and have those interactions in person and have more of them, especially if they're thinking about starting a patient on a drug. So, those opportunities to interact with physicians are still going to be there in a face-to-face manner. I don't think the field force is disappearing anytime soon. What I do think is going to happen is thinking about how to engage digitally with those organizations and our clients, thinking about that from a customer perspective, is going to be different. So, whereas before we may have thought about orchestration and next best action is something we needed to work on, I think they're going to become priorities and ways the organizations that get those things figured out first, are going to be super successful regardless of whether or not biosimilars are just regular old pharmaceutical products entirely.

CfB: As if biosimilar makers didn't have enough to contend with, such as increasing policy requirements, patent litigation, and payment policy hurdles, what other developing issues do you see out there?

Gatziolis: I brought up before this idea of a stable biosimilar marketplace in the US. Scott Gottlieb called the infliximab situation a broken market. Over the course of the time where there's been biosimilar competition, we've only seen about 15% of market share erosion, but there has been significant revenue erosion. So, when we look at it entirely, there has been a reduction in cost generated by treating patients with that particular molecule, including [the] biosimilar and the reference molecule. I think biosimilar manufacturers are thinking about “What is this marketplace going to look like long-term? And how viable is it going to be for us to have biosimilar assets for the second and third waves?” That's going to be a really interesting thing to track. That's the developing issue for 2020: Will the COVID-19 pandemic have an effect, either positive or negative, at developing that marketplace, so that we can continue to see the necessary biosimilar development for the second and the third waves. This is an important year for the 10 assets that have come out and for the companies that have made it a priority to bring biosimilars to marketplace. The COVID-19 pandemic could make things more challenging for them in terms of accelerating price competition, making companies fight each other for the different revenue share, or it could actually increase the overall penetration for biosimilars because hospitals, decision makers, buyers, and payers are going to be looking to bring them in faster than they may have before. Maybe if there was some reticenct share of the marketplace that wasn't looking to do that, now, they will be much faster and that could accelerate the erosion of the market share for the reference products.

CfB: And lastly, is there anything you wanted to add that has not yet been addressed?

Gatziolis: I don't think so. I think the number 1 thing is that the biosimilar situation is similar to what we're seeing for the reference product companies and for general pharmaceutical companies in terms of trying to get in front of physicians. Data have been shown to say somewhere along the lines of 50% to 70% of physicians are saying that it's a lower priority for them to engage with pharmaceutical companies. This is a place where biosimilars [manufacturers] can say “Our important actor is also the HCP but it really is some of those decision makers.” [They should] use this as an opportunity to have their time [and] make their case for why their asset is the right one for their organization.

CfB: Thanks, Will.

Gatziolis: Thank you.

CfB: To learn more, visit our website, centerforbiosimilars.com. I'm Matthew Gavidia. Thanks for joining us.