With the oncology biosimilars market poised for expansion, ZS launched an effort to survey the landscape. Our 2017 Biosimilar Adoption Study polled 252 respondents—including 200 oncologists, 25 payers and 27 pharmacy directors—and the results provide a perspective on market perceptions and other factors that could drive or restrict oncology biosimilars’ adoption.
The research is an extension of ZS’s Oncology Value Watchdog, which tracks initiatives intended to ensure the delivery of safe and efficacious treatments while considering the costs weighing on patients and the healthcare system as a whole. Here, ZS oncology experts Christina Corridon and Pavan Anne walk us through some of the study’s discoveries and market implications.
Q: Did the data gathered in your biosimilar adoption survey match your expectations?
Christina Corridon: We learned that oncologists are receptive to biosimilars, are ready to start using them with their patients, and are likely to discriminate a little less by tumor area or patient type than we might have imagined. The landscape is dynamic and Zarxio, the first U.S.-approved biosimilar and one that’s used as a supportive care product in the oncology setting, is relatively new to the market, so stakeholders are still trying to find their comfort zone.
We anticipate that the biosimilars sector will become more payer-driven once oncologists and payers become more comfortable. A payer-driven market will support the products that offer the most compelling discounts and contracts, and those could come from originator or biosimilar manufacturers. We anticipate that comfort will be driven by education first, followed by trial and then adoption, not unlike what we’ve seen in the traditional branded biologic space.
Some uncertainty remains, however, in terms of how educated the U.S. oncology community is, and whether the market will favor the originators or certain biosimilars over others based on factors beyond price. In the meantime, the concept of biosimilar interchangeability continues to raise scientific and policy questions because of its potentially significant commercial implications.
Pavan Anne: We found that oncologists, in general, prefer to select a biosimilar from a well-regarded and established biologic player. That finding has implications for some of the newer entrants in the oncology market that may not have the same reputation as the big players. It also has implications for originators that represent established biologic and oncology players.
About half of the oncologists surveyed said they would use therapeutic biosimilars immediately after approval and would readily switch current patients to biosimilars, but the skeptics hesitate to switch patients whose conditions are well-managed by branded biologics to biosimilars.
It’s important to point out that other stakeholders involved in the decision-making process can also influence prescriptions. Biosimilar manufacturers need to expand their focus beyond oncologists to consider all stakeholders such as the payers and pharmacy directors, and, in some cases, the caregivers and patients themselves.
Q: What do the study’s findings mean for oncologists, or for manufacturers?
PA: Physicians are interested in learning about biosimilars and how they can be incorporated into their day-to-day practice. It’s not a space that everyone is knowledgeable about, so biosimilar manufacturers need to make a conscious effort to build that knowledge within the physician community. It’s important for manufacturers to think about building their reputation as credible and reliable partners to the oncologists prescribing their drugs.
CC: Our research shows a readiness to adopt biosimilars. An important dialogue could be opened with the oncologists who are less apt to adopt: What’s driving the hesitation and what else would be required to overcome that hesitation? Is it a lack of confidence due to a lack of data and real-world experience? Is the discount deep enough?
We anticipate that biosimilar discounts will be set at a rate that allows manufacturers to deliver in the market but also “stay in business.” The discount needs to be at a rate that’s sustainable to maintain appropriate margin, however, the threshold may differ depending on the portfolio a manufacturer has at its disposal as well as costs of goods sold. According to our data, most oncologists, payers and pharmacy directors expect biosimilars to hover around the current 15% discount. Surprisingly, the pharmacy directors we surveyed would be comfortable with a discount that falls below that threshold. Discount and rebate programs will add further complexities, particularly with the economic incentives for institutions that are eligible for 340B pricing.
Biosimilars require a different selling approach [than reference products] that begins, first, with ensuring that the market is educated about, and comfortable with, the concept and the category. Second, the manufacturer needs to drive choice toward its biosimilar brand. The go-to-market strategy for a biosimilar, or its defense strategy as an early entrant biosimilar or originator already in the market, will vary based on the level of stakeholder engagement. To increase engagement, biosimilar manufacturers should profile various segments at an account and individual healthcare provider level, and increase education efforts where needed.
To improve a physician’s comfort level, for example, the manufacturer might focus on providing the right support, ensuring that biosimilars are available at the prescriber’s institution or making the act of filling a prescription seamless. Originators of the reference product will need to understand where their product fits in and provide differentiating value in the marketplace for these segments.
Q: How do your findings fit into the current industry conversation about biosimilars?
CC: We’re starting to see more discussions about where specifically (which patient types, settings, etc.) biosimilars fit in and how they can help deliver value-driven care. The oncology arena needs to continue to figure out biosimilars’ role in delivering efficacious and safe care while driving down costs.
An area where trepidation remains, and rightfully so, is determining when it’s appropriate to switch existing patients onto a biosimilar versus reserve biosimilars for treatment-naïve patients only. Our research is another conversation starter in the dialogue about where biosimilars fit into the treatment paradigm, and what role payers and pharmacy directors play in driving uptake.
PA: The industry conversation revolves around two topics: first, how biosimilar manufacturers can bring these innovative biosimilars to market and help patients get access; second, how the originators can differentiate their originator molecules. But the topic that’s being overlooked is what effect biosimilars will have on companies that aren’t directly influenced by the biosimilars.
Oncology biosimilars could play a big role in our healthcare system’s transition to value-based care, but manufacturers will have to address the marketplace’s questions and perceptions as to biosimilars’ safety, efficacy and overall value. In the meantime, several factors—and stakeholders—will continue to drive or restrict the adoption of oncology biosimilars as they enter the market. It’s up to the manufacturers to alleviate some of the biosimilar safety and efficacy concerns with real-world evidence and additional clinical trials. Similarly, originators can continue to lead the way with their legacy of experience, availability of real-world data and robust support services.
If you’re interested in continuing this conversation, please register for our July 27, 2017, webinar, “The Advent of Biosimilars in Oncology: Planning Proactively for Change.”
| Three Key Takeaways for Manufacturers: