Optimizing Transitions to Biosimilars

Ryan Haumschild, PharmD, MS, MBA, discusses optimizing the transition to biosimilars, covering from what patients to look for as candidates to the process of switching a patient from a brand to a biosimilar to the importance of patient education.

Ryan Haumschild, PharmD, MS, MBA: I believe in the science of biosimilars. I’ve done a lot of research and looked into the FDA, and seen data around great patient outcomes with biosimilars, especially in Europe, and now here in the United States. There have been a lot of data published. Biosimilars are great candidates for all patients. I wouldn’t want to treat 1 patient population one way, and 1 patient population another way. But if we’re looking at who’s going to be the strongest candidate for biosimilars, I would focus on patients who are dealing with financial toxicity, where they have coinsurance, and there’s of out-of-pocket expense. If we can give them a product almost like a generic, that reduces the expense of the drug, that could reduce their coinsurance and allow them to afford it, that’s a great thing. For patients who are new to starting therapy, it might be a great option for them. Some patients who I would consider in terms of switching to a biosimilar from a reference product, I would say, especially patients where there isn’t concern about immunogenicity, patients who may be starting a new cycle of therapy. You can consider patients who are stable on therapy, we’ve seen really good results, but again, it’s going to come down to how stable has that patient been. Did the patient just become stable on the reference product, and maybe the timing isn’t perfect to switch them to a biosimilar? Or someone who’s been able for a while on the reference product, and all clinical indications say that they’re going to do well if they switch to the biosimilar. That’s how I’d stratify patient populations, but overall, biosimilars are great options for all patients regardless of status.

This is going to be a tough situation that we’re going to be challenged with. With all the biosimilars coming to market, is every patient the perfect candidate to switch from a reference product to a biosimilar? It depends, as we know there are patient-specific factors. If someone hasn’t been doing well on the reference product and is still trying to get established on that product, maybe it’s not the best time to switch into a biosimilar. If their reference product has some type of citrate-free additive that gives it less burning at injection site, which causes a lot of pain for the patient. Or if the patient just switched from the reference product to another reference product that’s citrate-free, that may not be the best time to switch them. There are a lot of clinical considerations, and there’s not a one-size-fits-all approach, but the majority of patients will do well transitioning to the biosimilar, but there’s some that won’t and that’s OK. We can keep them on the reference product as long as the team feels it’s appropriate and the patient’s responding well.

We’re always looking at patients who have the potential to reduce their out-of-pocket cost. We always look at patients who have the potential to have their medication therapy optimized. That’s our responsibility as a health care provider to make sure we’re doing that due diligence for the patient. A lot of patients can be identified as candidates to transition to biosimilars, and it’s going to be safe and effective for them. Particularly we may look for patients with high out-of-pocket expenses, patients who have had difficulty covering their coinsurance. For the most part, patients who are starting on therapies where there are strong data in terms of switching from the biosimilar to the reference, and the reference to the biosimilar. There are also data internally around biosimilar use as part of starting a new treatment regimen. Those would be patients we’d always look at for starting a new therapy, and that would be driven more from that order set perspective because we always want to do what’s best for all of our patients and not single out any unique patient. We would do it from a disease state, get the provider buy in, and start patients on biosimilars. If we were going to do a one-off scenario, I would look for patient out of pocket expense, and make sure if we’re going to switch a patient in their specific therapeutic area that there is a good amount of switching data available that we could reference to ensure that they would have a good medical outcome.

Patient education is a huge part of the process when you’re transitioning patients to a biosimilar, not just new start patients, but more importantly, patients you’re transitioning from a brand or reference product to a biosimilar. Rightfully so they may be hesitant. They may be wondering why they’re changing their therapies. And you never want a patient just to show up, sit in a chair and look up at their medication and go, “I’m receiving a different type of medication than I normally receive. Why is that happening to me?” No. 1, it’s being really proactive and making sure that patients understand biosimilars. It’s easier with new start patients because it’s the first time they’re receiving therapy. We can educate them in the clinic that they’re going to be starting a biosimilar, and that they’ll continue that for their treatment scale. For patients who are on a branded product, who are relatively stable, you want to make sure you carve out time for them to provide them education around biosimilars, the importance of reducing total cost of care, how these molecules are highly similar to the reference product, and that they’re treating provider feels comfortable with them transitioning from the brand to the biosimilar.

Lastly, you want to leave them with education. You want them to be able to think about the decision, understand what we’re going to do, and transition them and give them some lead time. If they have enough concerns and want to opt out from transitioning to a biosimilar, you’re able to have that conversation with the patient and give them time to digest all the information. When you do it that way, and you’re proactive in your approach, patients tend to understand better and have time to process the information. Usually, they’re going to be a lot more onboard and understand the value of biosimilars than if you just start them on a biosimilar without going through that proper education sequence.

This transcript has been edited for clarity.

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