Gary Lyman, MD, MPH, an oncologist and hematologist, gives his thoughts on whether health care institutions need to be doing more to encourage use of biosimilars.
Gary Lyman, MD, MPH, is an oncologist, hematologist, and public health researcher who has long been an advocate for biosimilars. He has also developed guidelines in support of using biosimilars in the oncology space.
Do you think health care institutions need to weigh in somehow to facilitate the use of biosimilars in the clinic, and if so, how?
I think it's a 2-way street. I think health care providers and institutions need to be fairly proactive in making their case for the use of these agents. I think payers, the providers, and the health systems need to reach out to the users to indicate what their perspective is on it. Basically, an effort to come to terms so there's an alignment of what is encouraged by the clinical community for a particular condition and what the payer is willing to reimburse in terms of actual agents.
Unfortunately, those lines of communication are often frayed or nonexistent. So, if a patient has been on a biologic therapy, has done well, and all of a sudden, they switch insurance companies or a payer decides to change its favored biologic, then the clinician either needs to prescribe the new favorite agent or to render a request or an appeal to be allowed to use for that patient the agent they've been on, for continuity.
I think that's where clinicians get a little anxious about switching an agent in the middle of a course of therapy, particularly if it's being used with curative intent. It's not that they necessarily disagree or don't believe the FDA regulatory process has demonstrated that these [agents] are highly similar [to the reference product], but they're not exact copies. They're not generics. Even if it's just for a laying patient who's concerned with why they're getting a different drug than they were getting 3 weeks earlier. All this, I think raises some concerns in clinicians about switching or changing in the middle, particularly if they have not been told about it. And this is another issue that comes up about notification and approval of agents in the midst of a course of therapy for patients who are being often treated for curative intent.
So, I think it's essential that those lines of communication be there and that the views and rationale from both sides are put forward. I don't know what the final answer is. Perhaps a joint committee with representation from the payer community that holds the purse strings and a clinician or health system that does the prescribing and is basically trying to serve the interests of the patient. Of course, the patient is left in the middle of all this and is not quite sure what's going on. I think we really need to find a way for more routine regular and patient-centered alignment of the interests of both the payer and the provider for the best interest of the patient.