Biosimilar Series: Part 5

In this episode, the fifth of our biosimilar education series, Neil Udovich spoke with Kathy Oubre, CEO of Pontchartrain Cancer Center, about operationalizing biosimilars into practice and the differences and similarities of this process for biosimilars versus their counterparts.

If you have any questions for our guests or have a topic you would like to learn more about, email us at OnCall@cencora.com. 

Transcript

[00:00:33] Neil: Kathy! Hello again. Last episode, we started talking a little bit about the operationalization of biosimilars in the practice.  So let's just kind of go over again. What are some of the considerations that a practice needs to take into consideration when adopting biosimilars and putting it into a patient's treatment plan?

[00:00:55] Kathy:  So I'll kind of  start with how we started, you know, operationalizing these into our organization. And we really kind of followed the philosophy that it was important for all stakeholders within a practice to have a working knowledge of biosimilars.

You know we started with the physicians and our nurse practitioners, you know, around the science, behind it and the why. And then we actually spent a lot of time with our nurses because, you know, as most practices know, that's where, the patients and the nurses probably have the closest relationship and they spend the most time together.

Our nurses needed to understand the why behind why we were doing this, you know, to their patients as they like to protect, take care of them, but we also spent time educating our financial assistance team because if they're making the phone calls to the patients, obtaining information, to be able to get financial assistance, we wanted to arm them with the why as well.

You know, and it's, not about it being a cheaper product. You know, we, we quickly dispel that kind of messaging, but what we were talking about and the way we messaged it to everyone was the signs behind the biosimilars and the why. And what we did see in our organization was that we were able to you know, provide these high quality, lower cost products to our patients and, you know, society as a whole and at, at a practice level as well.

You know, we deal every day with these terms of financial toxicity and what that means to our patients. And so by being a biosimilar friendly practice, we actually saw increases in access to care. You know, especially in the Pegfilgrastim space, which is sometimes a product that patients elected not to get on day two.

Simply because of the high cost of Pegfilgrastim, but we also saw it, you know, be a lower cost alternative, you know, even in the therapeutic space. And it really is important, to be able to provide those kinds of things to our patients. You know, I kind of like in the effect of this, to buying a car.

You know, patients may have a $6,500 deductible and they're going to owe that. But utilization of biosimilars, at least in our organization helped lessen the blow upfront. So, you know, January deductibles are due and you, you know, you have a $6,500 deductible, but the usage of biosimilars allowed patients to kind of stretch those payment.

Or paying into that deductible over a longer period of time. And that way helped alleviate some of that financial toxicity burden. You know, when we're talking about, you know, we're also in the middle of an inflation right now, and we've been struggling through COVID. So some people lost jobs, some people had reduced wages, so it allowed them to, you know, stay on therapy. We did see increased adherence . But also it helped alleviate that financial burden up front, as they're looking for ways to also continue to pay, you know, mortgages, food and transportation costs,

[00:04:44] Neil: As it relates to a patient feeling comfortable around the utilization of a biosimilar, what type of education have you had to provide to patients, if any?

[00:04:57]  Kathy: We did some very rudimentary things around patient education. You know, the FDA actually, you know, did a pretty good job of offering biosimilar education on their website. And a lot of the pharmaceutical manufacturers did the same thing. So we really kind of took the best of several different sites, pulled it all together and made it our own. We really didn't get, we were, we were very upfront with our patients around the utilization of biosimilars because we did of course, resend these patients when we were moving them off of the originator products. It also helped us keep track of that almost as a, you know, a postmarket surveillance, you know, in our own practice.

My personal preference in that of our practice, you know, to resend a patient when you are moving them on, around on biosimilars or from a originator product to a biosimilar, because, you know, although these things are, these products are supposed to be, you know, biosimilar with no clinical meaningful differences. I feel better having informed consent. Just to protect our, you know, the organization and, you know, also have a level of transparency with our patients.

[00:6:27] Neil: Sure, very important

[00:6:30] Kathy:  Now, you know, going back to operationalizing these within the organization. So again, you know, starting with the MDs and the nurse practitioners, nurses, financial assistants, we even talked to the MAs about this but again, you know, operationalizing these products within an organization starts with the payers. We have to obtain authorization for those products. Again, you know, talking about parity preferred and non-preferred, and then it's important that a practice have a discussion with, you know, those relevant stakeholders at the practice on how to appropriately pull these through.

So at our organization, We, we keep a running quarterly spreadsheets in the financial assistance office who also handles the authorizations of all of the payers and their preferred or non-preferred products or parody per se. We also keep that in the, you know, in the treatment rooms. So, you know, so when the nurses are pulling the products out of the nucleus, they are double checking and we have a little bit, we have a popup box that we built into our EMR that says, you know, are you sure you are giving X to Mr. Smith.

You know? And it was a good, I'm glad we did it because it was just that brief little stop gap that made those nurses kind of stop and think. I'm carrying three Pegfilgrastim and I'm in a hurry. You know, I've got, you know, 30 people in my treatment suite and it really did help against administering that non-approved product to the patient.

[00:08:20] Neil: Generally speaking, however, the authorization process of starting someone on a biosimilar is not too markedly different than starting a patient on any other drug. You still have to go through the authorization process, you still have to make sure that the insurance company is going to, to approve that particular drug in that particular instance. Is that a correct statement?

[00:08:46] Kathy: Yes. I mean, these are just additional drugs that we're incorporating into our organization. You know, there's, there should be no differences in obtaining prior authorization, but it is important to obtain that prior authorization for the specific product. You know, because again, if you administer an unauthorized drug to the patient, you run a high likelihood of not getting reimbursed.

And it is important to ensure when you are doing a reauthorization on an existing patient to in, you know, see if the payer still has that product on, you know, preferred non-preferred parody. And because you don't wanna get into the idea of thinking, well, they're gonna grandfather them and you being correct.

[00:09:39] Neil: You mentioned earlier patient assistance, patient assistance programs.  How robust are those types of programs with biosimilar manufacturers? And do you use them in your practice?

[00:09:52] Kathy: Well, we use all patient assistance programs, copay free drug, and such within our organization, regardless of the product.

You know, the only differences that I can think of would be in the different manufacturers and their, you know, their specific offerings. So for example, you know, to qualify for copay assistance, some may have a threshold of 300% of federal poverty level while others may set that threshold at 500. I do see that most biosim manufacturers do have patient assistance programs, which they need to have to be able to compete in the space because certainly anything that the reference product offers from that side of the house would need to be available for an overall successful adoption of a biosimilar, you know, and it's also important to note whether these biosim manufacturers. Have free drug programs for uninsured patients and, you know, some may and others may not.

And it's also important to note that if a patient is not eligible for manufacturer assistance, that you may see some variations in what foundations offer, meaning that some may only offer, assistance for the reference products, or they may only offer assistance for a very limited amount of the biosimilar manufactures.

[00:11:21] Neil: Great. Well, once again, I'd like thank you for your insights and your time today.

[00:11:27] Kathy: Thank you very much. I enjoyed it. I hope it was helpful.

[00:11:30] Neil: Absolutely.