Biosimilars, Explained

In this Cancer Care Business Breakthroughs, John Hennessy, MBA, Valuate Health Consultancy, reviews how biosimilars have changed the cancer treatment landscape and the ways they have—and have not—lived up to their potential yet.

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Transcript:

John Hennessy, MBA: Hi, I’m John Hennessy. I'm a strategist and principal at Valuate Health Consultancy.

What are biosimilars? The lay person’s view is, it's kind of the middle ground between a biologic and a generic. In other words, it's not quite the originator biologic. It's a similar product that does similar things, but it's not quite the same. It's not a generic; it's a different type of therapy entirely there, but people think of it as sort of an amalgam between the two. In other words, it's not the originator product, but it does things in a similar fashion, and we have both a biosimilar and also something called an interchangeable biosimilar. And the interchangeable biosimilar has done a little bit more work to show that you can use it sort of interchangeably, is the language to use, between the originator product and this new product, and you can do that in a way that you don't necessarily have to tell the patient you're doing it. In other words, a pharmacist can make that sort of interchange.

And that, I think, offers a lot of flexibility in terms of utilization. But what I think it also makes you think about is, how do you have these conversations with patients when you're looking at a therapy they're used to, or a therapy they're expecting, and maybe something that might be a little bit different in terms of how it's delivered to them. So, it creates both, you know, as many things do, sort of an opportunity and a risk at the same time. But what biosimilars are essentially trying to do is look at what the originator product does and see if we can deliver the same results with a similar product.

Let's think about how different stakeholders think about biosimilars. And I think it's first challenging to put everybody in the same bucket. From a provider standpoint, I think biosimilars offer both an opportunity and a risk. From an opportunity standpoint, I think it provides more choices to give patients a therapy that changes their lives in a positive manner. I think it creates the opportunity theoretically to have a more affordable choice or a more economically sound choice, and it might be economically sound for both the practice, but also for the patient. But I think it causes some conversations that are a little bit difficult. I think patients who are unfamiliar with the concept of biosimilars, or have experience with a certain product, might wonder why they're switching to another one, when what I'm using right now is the same.

Not all biosimilars are necessarily going to be less expensive than the originator product. In fact, in many cases the originator product becomes more affordable than the biosimilar around early launch time. So, I think it's challenging for those stakeholders.

I think, for the patients, it's kind of the same way. You know, I think for patients there are some who I think will appreciate the opportunity to have more choice and to have maybe a more economically sound option for them. But others are going to look and say, “I just want the original product, because it's always worked for me, and I think it will still work for me. And I don't want to make a change unless someone can give me a really positive reason why I should do that.” I think payers are in the same boat. Many payers have become very comfortable with originator products, and we all know there's contracting going on out there, and some of that contracting is really favorable, and that's really hard to walk away from. Other payers will see this as an opportunity to sort of change the market very drastically.

I think there is certainly someone innovating in this space coming from a network TV show who's having a lot of noise about what he's doing and creating opportunities in this space. So, I think it really does, from a payer standpoint, and particularly we think of self-funded employers, really offers opportunity to look at what attributes matter to you, and can biosimilars give you an opportunity to, you know, fit those attributes to what's important to you in a way that you couldn't do before these opportunities existed.

So, have biosimilars lived up to what we hope they would be? I think, yes and no. I recall going to ACCC meetings, you know, 10 years ago, where, as a practice leader, we were looking at biosimilars and saying, “Ah, this is an opportunity here. We can do something good for the practice economically. That's something good for the patients economically, and this will be a game changer for us.” I don't think we anticipated the payer role in biosimilars and the payer role in directing preferred biosimilars or preferred brand over biosimilars. I don't know that we anticipated that, so I don't know that we realized everything we'd hoped we would. But there's no question that the introduction of biosimilars are doing things to reduce the total cost of care and doing things that are good from that perspective.

But I think there are complicating factors that we really didn't think about. I think if you talk to an oncology practice today who's looking at biosimilars in the growth factor area and trying to keep track of what growth factor they can use with which health plan. I don't think we really thought that was going to be a challenge for us, but it certainly is a challenge going forward. It's certainly going to be a challenge as we see this in more spaces.

So, there are parts of the promise that I think are well delivered. I think there are complications that come along with that. That's kind of what innovation is. You know, the first electric car, you know, when they first started coming out, we thought, oh, this is great, electric cars everywhere. And then we had to find a charger. And then we had to find a charger to fit our car. So, this is what innovation’s about. It's, you know, two steps forward, one step back.

What I do think is that we will continue to see steps going forward. And I don't know that we really have a good sense of where this all ends. But I think the idea that it gives us an opportunity to increase affordability in certain products, and maybe in the long run, you know, create an economic model that allows us to afford some of the really interesting new technologies and new therapies that are coming, you know, sort of keep the total cost of care, you know, in a sustainable way.

When you think about what effect biosimilars have that are good and bad, I think it's destabilizing. I think that's both a good thing and a bad thing. You know, from a practice standpoint to the extent that destabilization improves affordability for patients or improves the practice performance, that's a good thing. I think the destabilization in terms of trying to keep track of which therapeutic is approved, by which health plan? That's destabilizing in a bad way. So, I think there's a balancing act there that I don't think we've necessarily settled out on, and each introduction of a new biosimilar for an existing therapy sort of makes that a little bit more complicated, and at some point the complications go up and the rewards go down.

But certainly the idea that the introduction of biosimilars is going to reduce that cost at some point, I think we're there. I think that the things that come along with that are a little challenging. But we're going to have to get used to it, because I think if we look at the pipeline, there's more coming. In oncology we're maybe a little more mature than other spaces. I think we're going to be interested to see how other specialties where these biosimilars are coming and coming fast, particularly in immunology, how they adapt to that, and how they have to adapt their practice patterns to that. I think it'll be really interesting.

When thinking about bioimilars, I think it's a really exciting opportunity. I think you have to understand that there's good and there's challenges. But that's kind of what we've been doing in oncology for the last 30 years is, how do we acknowledge the fact that there's good things happening in terms of new therapies and existing therapies getting less expensive, creating more opportunities for us.

At the same time, we're challenged by reimbursement, we're challenged by operational issues, prior authorizations, all those things. So, biosimilars, I think, offer a unique opportunity in that ecosystem. And it's one of those things that we, in good oncology practices, have done for a long time, which is, you adapt, you change, you develop new processes. And you do your best from that point forward to take care of your patients.