Stephen V. Speicher, MD, MS, senior medical director and head of Healthcare Quality and Patient Safety at Flatiron Health, discusses his upcoming Association of Cancer Care Centers 50th Annual Meeting & Cancer Center Business Summit (AMCCBS) poster presentation titled “Technology for Substituting Biosimilars to Improve Practice Efficiency and Financial Health.”

Transcript:

Stephen V. Speicher, MD, MS: My name is Stephen Speicher. I am a senior medical director at Flatiron Health, and I oversee patient safety and health care quality for all of our point of care solutions used by oncologists. I am a pediatric hematologist and oncologist by training. I still practice.

Regarding your poster presentation “Technology for Substituting Biosimilars to Improve Practice Efficiency and Financial Health,” can you elaborate on how the point of care solution contributes to the financial health of community oncology practices, particularly in efficiently managing insurer preferences for biosimilars?

Dr. Speicher: One of the things that we've been hearing from our practices over the course of several years is the kind of rapidly evolving state of some of these biosimilar drugs. So biosimilars are these drugs that, like their name implies, are pretty much biologically identical to a reference drug, if you will. So everything from the safety profile, the efficacy, those have all been kind of cleared by the FDA for a reference drug. And now we have these kind of biosimilar alternatives that are oftentimes less expensive but still equally efficacious. So we were starting to see really this evolution of this rapid onset of all of these biosimilar drugs. And what we're finding from practices is that it was extremely hard to manage all of these insurer preferences for these biosimilar drugs. And what that was leading to ultimately is that practices were losing out on financial opportunities because they were prescribing a drug that was not insurer preferred.

And what that was ultimately contributing to was a very manual process by which you had clinicians, pharmacists going through regimens on a patient by patient basis to really try to weed through what is the insurer preferred drug and how do we make sure we make that swap most effectively? We see this in a variety of different drugs, but it was becoming increasingly apparent that this was something that we really needed to try to solve for and hopefully use technology to really leverage that. So our development team took a look at that problem and really looked at how can we best enable practices to do this? How do we utilize technology in a way that can efficiently take a look at several different drugs, take a look at a reference drug, take a look at insurer, preferred biosimilar drug, and make that swap in a way that we don't have such a manual process around that. So that's what we kind of sought out to do is to develop technology that would allow us to do that, allow our practices to do that.

How does the technology presented in the poster integrate biosimilar substitution within the EHR to enhance practice efficiency, and what specific cost implications does it have?

Dr. Speicher: The current state, I alluded to this in the first part of the question, but the current state was that pharmacists or clinicians were having to go through, they were having to take a look, okay, what is the drug in this regimen? Is there a biosimilar for it? Is there an insurance preference? What is that? What is that patient's insurance currently? And then make that swap in the actual regimen. We were finding that was an incredibly manual process. It was very time consuming. And so what we sought out to do was to really build technology around that. So what the integration of the biosimilar functionality looks like in the EHR is that practices are able to go in, they're able to take a look at specific biosimilar drugs. They're able to take a look at the reference drug and the FDA approved biosimilar options, and they're able to set specific insurer preferences.

They can set a blank standard across the board. So for every patient that comes in needing Neulasta or Avastin, we're going to make one specific swap across the board for all of our patients. Or you're able to really take a look at it on an insurer by insurer basis. So you're able to say, for a patient with this specific insurance, please make the swap from this reference drug to this biosimilar drug. What that does is essentially at the point of care, so as an ordering physician, if I'm placing an order, a regimen that has a specific drug in it that has a biosimilar option, our technology evaluates that there is a biosimilar option. It looks at this kind of set standard that is set by the practice and when appropriate it will make that change. It'll make that swap for the preferred drug for that specific patient. What we're noticing is that there's tremendous cost saving opportunities for our practices. Our practices are able to really hone in on what drug is going to be cheapest for them, and that is huge for our practices. Community oncology is a field that is incredibly important in the overall care of cancer patients throughout the country, and financial stability is one of the main things that we are really working with our practices to ensure so that we can make sure that these community oncology practices stay in business.

What has been the user experience among health care professionals adopting this technology for biosimilar substitution, and are there strategies in place to encourage widespread adoption within community oncology practices?

Dr. Speicher: With any new technology, there's change aversion. People in general, human beings don't like change. Anytime we're incorporating a new technology, we always worry about how are these things going to be adopted by clinicians specifically. That's been a process over the course of the last couple years as we've rolled out this technology. But what we've seen is that for the practices that use our drug substitution and functionality, we're getting really very positive feedback across the board. We're getting some significant qualitative feedback that talks about how convenient it is, how much it optimizes the workflow for the individuals that were previously having to do this on a very manual basis, and then really starting to see some pretty significant cost benefits from our practices. They're saying that this is saving them money, so we know that that's crucial, and we're listening loud and clear on that. What we've seen from looking at the actual numbers, we've seen a 20% increase in biosimilar ordering since the feature was launched.

So what we've seen is across our Flatiron Health Network, we're starting to see a majority of our practices really start to increase the use of biosimilars. We're starting to see the reference drug usage go down. What we know is that the reference drug is going down mainly because the insurance preferences are starting to change and evolve, and ultimately, anytime a biosimilar is ordered over a reference drug, that likely is related to specific cost savings for our practices. So we think that is an incredible indication that our practices are really utilizing this. They're enjoying as much as you can, enjoy any technology. They're enjoying the use of it, and it's saving them money, which is incredibly important for them.