Survey Results Provide Insights into Biosimilar Use at Cancer Centers

February 2023, Vol 14, No 1

Results from a survey of cancer centers revealed that 66% of responding institutions had a biosimilar interchangeability policy in place, but barriers to adoption remain an issue. The findings from this survey were presented by Marina Reed, PharmD, Clinical Pharmacy Coordinator, Hematology/Oncology, Roswell Park Cancer Institute, Jamestown, NY, and colleagues, during the 2022 American Society of Clinical Oncology Annual Meeting.

Of 179 surveys initiated, 50 unique surveys were completed, with 21 responses generated from National Cancer Institute–designated comprehensive cancer centers. The 40-question survey gathered information about biosimilar adoption from the perspectives of formulary management, product usage, policies, technology, safety, and education. Bevaciz-umab (Avastin), filgrastim (Neupogen), epoetin alfa (Epogen, Procrit), infliximab (Remicade), pegfilgrastim (Neulasta), rituximab (Rituxan), and trastuzumab (Herceptin) biosimilars were evaluated. Barriers to biosimilar adoption were also assessed. The survey was distributed to Hematology/Oncology Pharmacy Association members.

“Inpatient formulary decisions were driven by acquisition cost followed by reimbursement. In the outpatient setting, equal consideration was given to acquisition cost and reimbursement for formulary decisions,” Dr Reed and colleagues noted.

Biosimilars were restricted to their approved indication by 32% of the institutions. Biosimilar utilization was 74% for bevacizumab, 88% for filgrastim, 82% for epoetin alfa, 52% for pegfilgrastim, 73% for rituximab, and 71% for trastuzumab. More than 90% of responding institutions had a preferred biosimilar on formulary.

Approximately 72% of responding institutions indicated that payers specified the selection of biosimilars and 76% said that payer reimbursement limited the ability to participate in contract pricing.

Major barriers to biosimilar adoption included the following:

  • Insurance coverage (82%)
  • Drug availability (24%)
  • Computerized provider order entry (24%)
  • Provider acceptance (22%)
  • Lack of policies/procedures (16%)
  • Monitoring/postmarketing surveillance (14%)
  • Cost to patient (12%)
  • Greater acceptance for supportive care versus therapeutic oncology indications (10%)
  • Patient acceptance (8%)
  • Other (2%).

One-fourth (26%) of institutions responding to the survey reported medication errors related to biosimilar use, with the most common being communication. Overall, 36% of institutions provided education on the general use of biosimilars and 38% included biosimilar products in treatment-specific education.

“Biosimilar adoption is consistent across responding institutions, with noted utilization shift towards biosimilar products compared to reference. Decisions for biosimilar adoption are made based on cost and reimbursement. Opportunities exist in the collaboration of health systems and payers to align formularies and promote safe and cost-effective care for their members,” Dr Reed and colleagues concluded.

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