‘Proactive education’ critical to preparing patients for likely biosimilar switch
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DENVER — Proactively educating patients on biosimilar efficacy and cost-savings associated with their use can help reduce anxiety and bias if/when their insurance opts to switch, according to a presenter at the Crohn’s and Colitis Congress.
“Biosimilars are important because we have seen that health care costs have dramatically increased over the past few years,” Ross M. Maltz, MD, a pediatric gastroenterologist in the Pediatric and Adolescent Inflammatory Bowel Disease Center at Nationwide Children’s Hospital, told attendees. “Based on wholesale acquisition costs, when infliximab [Remicade, Janssen] first hit the market, it was about $500 a vial; it has now risen to well over $1,200 a vial. Where adalimumab [Humira, AbbVie] was previously $500 an injection, it is now well over $2,500 an injection. Nothing has really changed with these medications, but the cost has dramatically increased over the years, well above inflation.”
Maltz noted that emphasizing the potential cost-savings of biosimilars over more expensive originator biologics could help open conversation with patients who may be otherwise hesitant about making the switch.
“Biosimilars, on average, are priced 10% to 15% below originator prices,” he said. “It has been estimated that if we increase infliximab biosimilar market share to around 50%, we could see an estimated savings of around $262 million. At Nationwide Children’s Hospital, we have been predominantly using infliximab biosimilars and our hospital has seen a $1 million savings annually over the past 3 years by incorporating biosimilars into our practice.”
In 2023, at least eight adalimumab biosimilars will enter the U.S. market, joining three infliximab biosimilars already available and setting the stage for a possible biosimilar boom, as insurance companies will likely be eager to add biosimilars to their formularies to take advantage of the cheaper medications vs. the originators. However, whether the cost-saving potential of biosimilars will trickle down to the patient level remains to be seen.
“I always get asked, what about out-of-pocket costs for patients and their families?” Maltz said. “Unfortunately, out-of-pocket costs in my experience have generally been about the same [for originator and biosimilars]. Copay assistances for pharmaceutical companies, at least, in my experience, with infliximab biosimilars are nearly identical; I’m not sure what that means for [pending] adalimumab biosimilars.”
Framing biosimilars as “reducing the cost of care” rather than a cheaper or inferior product would also help patients become acclimated to the possibility that their insurance may switch them to a biosimilar in the future. Maltz recommended that clinicians start this conversation with patients as early as possible.
“It’s really important that we are talking to them right at the beginning,” he said. “You don’t want to be giving them brand name medication after brand name medication and then, all of a sudden, you can only get approval for the biosimilar and you have to go back to the patient and explain what biosimilars are. We all have patients that have been on the originator for years, some who have gone through step therapy and multiple dose changes before they got on the right medications. Those patients are going to be nervous about switching.”
Maltz highlighted that all patients on originator biologics need to be educated now — “actually, educated yesterday and the day before that” — about the real possibility that they will be switched to a biosimilar product.
“When it comes to switching for those patients, I think proactive education can help reduce bias,” he said. “Tell them that you’re not switching them, but you want them to be aware of biosimilars because there is a high chance in the future they need may need to switch if the insurance mandates them to switch.”
Similarly, clinicians should be proactive on biosimilars, especially on reviewing which biosimilars are available in hospital pharmacies and, more importantly, which ones are covered by local health insurance plans.
“We need to be proactive on evaluating our local health insurance plans, and what is on their formulary, because we can influence our hospitals and our hospital formularies, about which biosimilars are carried in the hospital,” Maltz said. “Obviously, not all hospitals are able to carry all eight adalimumab biosimilars or all three infliximab biosimilars, but if we get a sense of which ones are on the formulary, we can help communicate with our hospital pharmacy and better support our patients. It’s best that you be proactive and figure out which medicine their insurance requires and start them off appropriately.”
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Maltz, RM. Presentation Sp23: Biosimilars in pediatric IBD: Making the switch. Presented at: Crohn’s and Colitis Congress; Jan.19-21, 2023; Denver (hybrid meeting).
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