A panel of experts reviews the emerging interchangeable biosimilars and best practices on how to educate providers and patients on these treatment options.
Ryan Haumschild, PharmD, MS, MBA: Speaking of those interchangeable biosimilars, Dr [Jonathan] Kay, what are some of the emerging interchangeable biosimilars for inflammatory disease?
Jonathan Kay, MD: The infusible biosimilars doesn’t need to be interchangeable because the infusion facility will infuse whichever biosimilars are on the formulary. And that decision is usually made based on costs. It’s the self-administered biosimilars that are given this interchangeability designation. And as of now, the first self-administered biosimilar for inflammatory diseases is going to be adalimumab [Humira]. The first adalimumab biosimilar, currently as of June 19, 2023, the only one to have the interchangeable designation is Boehringer Ingelheim adalimumab biosimilar [Cyltezo]. But Pfizer just published the results of their interchangeability study, a successful study, that was conducted in rheumatoid arthritis patients in Lancet Rheumatology and the FDA is currently reviewing those data. The Boehringer Ingelheim adalimumab biosimilar interchangeability study was conducted in plaque psoriasis and plaque psoriasis is an ideal condition in which to study biosimilars because the organ that’s involved, unlike inflammatory bowel disease where, unless you do an endoscopy, you can’t directly visualize the organ or rheumatoid arthritis. The organ is covered by skin. In psoriasis, you can see the extent of involvement. And there’s also no patient’s subjective measure that’s included in the Psoriasis Area Severity Index. So psoriasis is a great condition to study biosimilars in comparison to their reference products. And the first interchangeability study was conducted on plaque psoriasis.
Ryan Haumschild, PharmD, MS, MBA: Interchangeability seems like it’s going to be important, especially as we think about the pharmacokinetics and how pharmacists might interchange especially in the pharmacy benefit, because as we talked about, many institutions have PMT [performance metric tracking] policies that allow them to interchange, but this is a little bit different in the way it’s going to be filled. Dr [Maia] Kayal, what are some of the best practices, and how we can educate both providers and our patients on interchangeable biosimilars?
Maia Kayal, MD, MS: I think Dr Kay brought up a really good point before, which is you have 20 minutes with a patient to talk about their disease severity, their disease acuity, the medications that they’re on, how they’re doing, their comorbidities. And you really don’t have that much time to spend talking about whether the reference product or the biosimilar. But, within that time constraint, yes, patient education is important. But the top level of that is provider education. I think that’s a big opportunity to introduce biosimilars to our providers and to get them into the patient’s hands. A lot of our physicians and our nurse health care providers are busy. They don’t have necessarily that time they might not be the most up-to-date on the 9 biosimilars that you mentioned, which are already currently active as of June 19, 2023. And that’s where that education is important. Assuming that a provider knows that a biosimilar is available is not enough because I will bet you that many of them don’t necessarily know how many are out there, how many are already available to be prescribed to patients, how many are interchangeable, and what that interchangeability means. And even on another level, I’m not confident that many of our providers know necessarily that biosimilars have the same safety and efficacy profiles as the reference product. I think figuring out a way to educate providers before educating patients is key because they’re the ones that are going to be sending that message and relaying it along. But then, taking the time to make the announcement that these are the biosimilars that are currently available, what they look like because physicians and nurse providers are going to get those questions from their patients. So preempting what is going to happen later on, which is why does my pen look different? Why is this coming in a syringe when before it was an autoinjectable, for example? Why is the packaging a different color? These are questions patients understandably have when they’re dealing with a chronic illness, and they’ve been on the same drug for many, many years, and all of a sudden, everything is different. So I think assuming that physicians and nurse providers already have this information in mind is not a great way to approach it. I think taking that time to really educate them on the basics that we just discussed today. What a biosimilar is, what an interchangeable is, how the biosimilars are going to look differently and what the patients should expect, and what questions they should expect the patients to approach them with is key.
Ryan Haumschild, PharmD, MS, MBA: Great comments all around. Dr Kay, anything you want to add to that question?
Jonathan Kay, MD: Not really.
Ryan Haumschild, PharmD, MS, MBA: OK. All right. Dr [Kimberly] Chen as we think about best practices for providers and patients. What is the payer’s perspective on that? How can you be a part of that education awareness around interchangeability?
Kimberly C. Chen, DO, MSHLM: Definitely. Besides the provider education, I think you also look at the extended provider. And as I’ve mentioned, the health plan has a case manager who can continue to support the members as well as patients. But also looking at the pharmacist, as we know, pharmacists have been very, very instrumental in bringing that conversion and increasing the susceptibility and utilization of generic drugs. How can we leverage them to help support the integration of biosimilars and that whole concept as well? And then lastly, make sure we have patient-friendly language material to educate them and also share with your physician, extenders, physician assistants, and everybody else, because at the end of the day, I think sometimes they speak to our patients or members more than the provider themselves.
Transcript edited for clarity.
This activity is supported by an educational grant from Boehringer Ingelheim.