Fort Myers, FL—The majority (22 of 40) of biosimilars approved in the United States are used for the treatment of cancer or supportive care of patients with cancer, according to December 2022 data cited by the American Oncology Network (AON).

The organization, which comprises community oncology practices representing 107 oncologists at 76 locations across 17 states, embarked on a study to determine the effect of utilizing regional clinical pharmacists (RCPs) to assist with the selection of the most cost-effective biosimilar products. That is important, according to AON, “because our network faces formulary selection and reimbursement challenges related to a diverse payor mix across multiple states.”

The findings were presented recently at the 2023 American Society of Clinical Oncology (ASCO) meeting in Chicago.

In October 2021, the network initiated an RCP-driven biosimilar substitution program, with the pharmacists acting as liaisons between providers and financial teams to evaluate existing drug orders and their financial impact.

Data were previously presented on the financial impact on payors and providers before and after the implementation of the program from April 1, 2021, to April 1, 2022. The current study evaluated the 1-year results following program implementation and assessed outcomes related to biosimilar utilization as well as financial impacts to payors, patients, and providers.

The study defined payor savings as the difference of the calculated 80% Medicare ASP+6 (average sales price [ASP] plus 6% add-on fee) for the administered biosimilar compared with the originator. Patient savings was defined as the difference between the calculated 20% Medicare ASP+6 coinsurance for the administered biosimilar compared with the originator, and provider savings were defined as the difference between the invoiced cost of the biosimilar compared with the originator.

“By the end of 2022, preferred product utilization was achieved for >90% of bevacizumab, trastuzumab, and rituximab orders,” the study authors reported. “Use of the preferred pegfilgrastim product increased from <20% in 4/2021 to >60% by 12/2022. Use of filgrastim biosimilar product increased from <75% in 4/2021 to >90% by 4/2022, then decreased to 55% by 12/2022 due to trending ASP.”

One issue is that payor preference prevented biosimilar switching in approximately 34% of cases.

“Use of institution-preferred biosimilar products increased across all agents in this study after implementation of the RCP-driven biosimilar substitution program, except for filgrastim,” the study concluded. “Significant cost savings were noted for payors, patients, and providers. Barriers to switching to institution-preferred products included non-medical switching requirements by payors, patient assistance and compassionate use programs, and patient and/or provider preferences.”

In another study presented at ASCO, researchers from the Veterans’ Affairs (VA) Salt Lake City Healthcare System and Huntsman Cancer Institute at the University of Utah discussed the key role pharmacists’ interventions were playing in assuring adherence to targeted anticancer oral therapy initiation.

“Oncology pharmacists (OPs) increasingly play a role in managing cancer patients, with the availability of targeted oral anticancer agents (TOAs),” the authors wrote. “OPs ensure appropriate indications upon initiation; screen for, anticipate, and mitigate potential drug-drug interactions; manage side effects; and promote adherence.”

Yet, according to the researchers, the impact of OPs on adherence to TOAs has not been reported. To remedy that, the study team pulled data from the VA Corporate Data Warehouse and Cancer Registry.

The focus was on veterans with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL), marginal zone lymphoma (MZL), lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia (WM), and/or mantle cell lymphoma (MCL) who received single-agent TOA for the first time between 2018 and 2021. The researchers retrieved patient demographics, disease characteristics, and TOA dispensation information while also identifying visits with OPs within a 30-day window of initial dispensation.

Overall, 1,944 patients were identified, with a median age of 75 years. Nearly all patients (98%) were male. Among the patients, 1,498 (77%) were white, 244 (13%) were black, and 53 (3%) were Hispanic; the rest were “other” or “unknown.” CLL was the most common diagnosis, occurring in 1,578 patients (81%), followed by MCL in 162 (8%), WM in 135 (7%), and MZL in 69 (4%).

The authors noted that 1,702 patients (88%) received ibrutinib, 110 (6%) received venetoclax, 91 (5%) received acalabrutinib, and 32 (2%) received lenalidomide. Fewer than five patients received either idelalisib, zanubrutinib, umbralisib, and/or duvelisib.

The adherence analysis was conducted using 1,757 patients who had an initial dispensation supply of either less than 28 days or 28 to 30 days. Of those, 702 had met with an OP at therapy initiation.

The analysis found that, in the 239 patients with a dispensation day supply of fewer than 28 days, patients who met with an OP had higher 4-, 8-, and 12-week adherence rates (97%, 96%, and 92%, respectively) compared with those who did not (82%, 75%, and 72%, respectively). That translated to odds ratios (ORs) of 8.8, 7.7, and 4.7, respectively (all, P <.01).

For the 1,518 patients with a dispensation day supply of 28 to 30 days, patients who met with an OP also had higher 8- and 12-week adherence rates (96% and 91%, respectively) compared with those who did not (87% and 79%, respectively). ORs were 3.4 and 2.6, respectively (both, P <.01).

“Visiting with an OP upon TAO therapy initiation was associated with a clinically and statistically significant increase in adherence at 4, 8, and 12 weeks after first dispensation,” the researchers concluded. “To our knowledge, this is the first study to quantify the impact of an OP on non-adherence in a real-world setting. Our findings suggest a critical need to integrate OPs TAO therapy initiation workflows.”

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