Ivo Abraham, PhD, RN, a professor with the University of Arizona Health Sciences in the Department of Pharmacy Practice, discusses how the COVID-19 pandemic is likely to impact oncology biosimilar utilization.
Ivo Abraham, PhD, RN, is a professor with the University of Arizona Health Sciences in the Department of Pharmacy Practice. Abraham is also a health care consultant and co-founder at Matrix45.
A lot has been said about the health care system now having to recoup costs after the outlays for coping with the pandemic. Where do you think this might lead?
Abraham: The pandemic has been good for biosimilars because we've all been trying to figure out how to deal with the pandemic and how to reduce costs, in general, but also with the additional outlay that payers are experiencing with regard to covered lives who end up developing COVID-19. So, there is, in general for generics and biosimilars, a very strong reason to be continued. Also, we've built confidence. What it has shown us is that despite the fear mongering that we saw a few years ago, and that we saw 10 years ago in Europe—fear mongering about how these [biosimilar] products are never the same as the [reference] product or the biosimilar product is not the same from batch to batch—we're beyond that, COVID-19 certainly helped with that.
Another element to consider in this is that COVID-19 helped us with telehealth. Now, suddenly, CMS was beginning to reimburse for telehealth, which CMS resisted for a long time because of many reasons. We're going to probably see how especially provider organizations are going to deal with the costs, which is then going to go to the payers as procedures get picked up again and [providers] do more imaging. So, basically the things that are high-ticket items that can help them recoup costs.
The reality about biosimilars is despite a slow update in the United States, it has to do with the biosimilar companies thinking that they had to do door-to-door selling. They've got to go meet with big name and second and third tier big name companies to educate them about biosimilars. That was until they realized that's not the business model. The business model is to get big contracts. The United States should have learned that from Europe.
So, from that point of view, I think the good thing is, and also facilitated by COVID-19, is that now we realize biosimilars, certainly the ones in the United States, are just as good as the reference products and we don't have to worry about safety. Moreover, as a prescriber, we may have no choice what product we're working with.
As patients flock back to their doctors, many will be seeking treatment for later stage cancer than had the pandemic not occurred. Can you comment on this trend and what it signifies?
Abraham: As the surgeons are saying, the tumors are larger. Patients have been postponing screenings because of the pandemic. They may have been ignoring or trying to ignore certain symptoms. We also need to take into account that, in general and prepandemic, patients don't like to acknowledge that something might be wrong. I always say, if it's not right in the belly or it's below the waistline, men and women are very reluctant to admit that there might be a problem. Men with prostate cancer; women with some of the gynecological cancers; both genders with colorectal cancer. So, that's where COVID-19 no doubt has had a very bad effect.
I think we're going to see it in the statistics when they come out a year from now from cancer centers and what Cancer.gov puts out every year. We're going to see more stage 3 and stage 4 cancers. Now, on the other hand, these are also some of the cancers where in the last 15 to 20 years, we have made enormous progress. It's not that a patient with stage 4 colorectal cancer has very limited prospects. Now, they have a little bit more prospects. So, there's a certain buffer in that regard, but the reality is still that we were trying to be wise. I probably would have done the same thing and said, "[Screenings] can wait and this COVID-19 thing is going to be over in a few months," or something like that. And, yeah, the surgeons are saying the tumors are bigger.