Lower costs, increased availability, and assistance programs are “game changers” for patients.
This interview was conducted by The American Journal of Managed Care and has been lightly edited.
When biosimilars come to market, they bend the cost curve quickly and significantly, which makes cancer care more affordable, according to Andre Harvin, PharmD, MS, MBA. Harvin is the chief pharmacy officer and vice president of pharmacy services at Cone Health in Greensboro, North Carolina. However, he noted, there are challenges related to the finances of biosimilars, and decision makers need to understand how they pay for these products, whether there are any rebates or contractual arrangements in place, how much they’re charging for the products, and how they’re being reimbursed.
In his interview, Harvin also discussed incorporating a specialty pharmacy team into oncology care and how his team is starting to utilize artificial intelligence (AI) to give patients more access to financial aid.
What are some strategies that clinics and pharmacists can implement to increase biosimilar uptake and realize cost savings?
Andre Harvin, PharmD, MS, MBA: There are a lot of strategies that clinics and hospitals can utilize for biosimilar uptake. Probably the most important thing is to engage your pharmacy team. As pharmacists, we are your drug experts. We’re here for you. We’re in your corner. And we really understand the benefits that biosimilars have for not only your clinic but also your patients. One of the most important things is to start with education [and] make sure that everyone on the team understands what a biosimilar is and what it’s not.
The great thing about them is that the FDA has so many resources that really lay it out: the differences between that and a generic, any issues with things [such as] interchangeability, [and] how you can go about operating those.... And there [are many] publications that have been [published] in the past year that talk about successful programs.
Luckily, you don’t have to go it alone. You just have to make sure that you engage your pharmacy team and really focus on the educational aspect. Most importantly, you’re going to realize a ton of cost savings. And so, that’s exactly what biosimilars are brought to the market to do—they were brought in to bend the curve down in terms of our spending and overall [cost of] oncology care. The most important thing is that this helps patients and their access to really critical medications. So if you’re not using biosimilars, I think that’s the bigger question of how to best implement them.
How do you feel about the prospect of more supportive care biosimilars coming to the US market?
Harvin: This is one of the most exciting things when I think about the additional competitors that are coming to the market and biosimilar categories, especially when we think about the Onpro device [Neulasta; pegfilgrastim] that’s been so dominant in the market for so many years. This is a patient access issue, right? Some patients don’t have the opportunity or it’s difficult for them to come back to the clinic multiple days in a row. And that on-body [injector]— unfortunately, because of the patent surrounding it—has been able to be dominant in the market and continuously get more and more expensive.
Now we have new competitors that are coming on the market that will have an equivalent device so patients can receive their Neulasta on time, safely, without having to return to the clinic. It is really one of the most exciting prospects, I think, for the future of oncology care. We know that when biosimilars come onto the market, regardless of the product, they start to drive prices down, and they drive them down quickly and significantly. And this is exactly what we need to support as providers, as clinicians, [and] as supportive care services. We need to find ways to make cancer care less expensive, and I can’t think of a better opportunity than to have a biosimilar for the on-body [injector]. It’s going to be a game changer, and I’m really excited about it.
What else needs to be done to ensure that oncology and supportive care of biosimilars are affordable and accessible for patients with cancer?
Harvin: The affordability and accessibility that biosimilars bring to us cannot be understated. I think one of the challenges is how it relates to the finances of your overall cancer center. Sometimes there’s a lot of misinformation out there. Sometimes it’s disinformation as well. We have to understand what the finances are around how expensive medications are, what we charge—whether it be the insurance company or Medicare and Medicaid—and then actually understand how we’re reimbursed.
What I’ve been surprised by in my career is how few people in decision-making roles within oncology have a full grasp of how they’re reimbursed for medications. I encourage everyone…to actually sit down and ask those questions. Bring in your revenue cycle management team, bring in your managed care team, [and] obviously bring in your pharmacy team, because there are a lot of things at play here.
First, you have to understand how much you’re paying for the drug and if there are any rebates or any contractual arrangements that are important. Next, you have to understand how much you’re charging for it. But most important [is knowing] how much money is actually coming back in. We sit down and do that analysis. I think most people will find that biosimilars really afford them a much better financial picture than some of the reference products, and that’s why it’s so critical to really understand the financial implications of biosimilars rather than getting caught up in the previous dogma of more expensive drugs means higher margin. That’s not always the truth. Biosimilars have really changed the way we have to approach the finances of health care.
Once we do that, then we also have to think about the accessibility aspect. Depending on patients’ insurance, a more expensive drug may obviously decrease their ability to have access to that medication. If they have excessive out-of-pocket [costs or] if they have to be charged a percentage of the total charges [and pay] them out of pocket, some patients start making decisions based on the cost of their therapy. And that’s exactly what we don’t want to occur.
The other aspect that’s really great about having biosimilars and having a number of them on the market is that every single one of them has its own patient assistance program. And so, if there is a question of affordability [or] accessibility of care, the great thing is you can engage those manufacturers, you can find out what their patient assistance program is, and you can find ways to work with them to ensure patients have access to those critical medications.
What are some strategies for incorporating a specialty pharmacy team into oncology care that can optimize outcomes?
Harvin: Specialty pharmacies, when we start talking about those more expensive oral oncology medications that continue to come to the market, these are game changers. There’s really no other way to say it. With a specialty pharmacy before, when a patient had to have a toxic antineoplastic medication, they had to come in multiple days for an infusion. Now we have options to send them out of the clinic with an oral medication. Some of them can be taken daily, some may have a little bit more rigorous schedule, but now they don’t have to come back and have an [intravenous line] tied to their arm; they can take this oral medication and have similar or sometimes even better outcomes.
The really great thing about that is if you’re not doing specialty pharmacy, then the question is: Why not? It’s such a big area of growth; it’s such an opportunity not only for your patients, but…there’s a huge business behind it as well that is exceptionally profitable. You want a highly trained individual who is a specialist in those medications to be able to talk to patients about it. When these new medications that are coming out are 6 figures in terms of their annual costs, and some of them over a quarter million dollars for their annual costs, as a provider—and you have to think about [the] other side as a payer, as an insurer—you want to ensure that the patients are getting the full value out of that.
What better way than to have a highly specialized, highly trained individual like a pharmacist to help them on that journey? Specialty pharmacists reach out to patients at [regular] intervals before they do any refills. They make sure they ask patients critical questions about how many pills they have left [or] if they’ve had any difficulties. They can help manage adverse effects before a patient makes a decision not to continue taking the medication…. Your specialty pharmacist can not only ensure that your patients are going to adhere to their drug—therefore having a higher chance of getting that clinical outcome—but they’re also going to make sure that they’re getting the full value out of that medication and that we prevent a patient from stopping that drug prematurely.
There are only benefits, I would say, to having a specialty pharmacist as part of your program…. Once you get it up and running, you’ll see the value immediately.
How have you incorporated AI into your daily practice?
Harvin: For us, AI is something we’re just starting now. We talk about advocacy for patients, and the really difficult part of that is there are so many different programs, there are so many different grants and funds available, that it’s hard to keep up with. [When] a patient comes in and they’re diagnosed with cancer, the last thing they should have to worry about is how they’re going to afford that medication. I think that’s really on us as providers to ensure that they understand all of the benefits that are available to them on the market.
But if you think about that, that’s really tough. It depends on the drug, it depends on the manufacturer, it depends on the disease, the diagnosis, the patients’ characteristics.... There [are programs] out there that can assist them. And really, what you come to is that there’s not one person who could find everything that’s available to that patient. So what do we do? Well, we turn to AI.
We’ve just partnered with a third-party vendor that is going to help us do exactly that. They have an AI engine that constantly surveils philanthropic aid that’s available to patients undergoing cancer therapy and connects them directly with that. The great thing is that patients don’t have to come in and fill out forms, they can do it all over their phone. Then the next thing you know, either they’re getting free medications [or] they’re getting grant dollars, [and] it also has social support dollars, as well. So if that patient has trouble getting to and from their appointment, they can find things like Uber [to] give them a specific credit to help them get to and from their appointment on the day of their infusion.
[There are] a lot of different things that normally we would never be able to get to, opportunities for the patient. But by leveraging AI we can now do that.