Jamestown, NY—The biggest barrier to the use of biosimilars in oncology is the lack of insurance coverage, according to a survey of Hematology/Oncology Pharmacy Association members.

Noting that use of biosimilars is an effective strategy in expanding access to care and lowering healthcare costs, a presentation at the recent American Society of Clinical Oncology meeting explains that information about biosimilar adoption in oncology is limited.

To remedy that, a study team from the Roswell Park Cancer Institute in Jamestown, New York developed a 40-question survey to gather information about biosimilar use in the following areas:

• formulary management
• product usage
• policies
• technology
• safety
• education.

Evaluated in the survey were the following biosimilars: bevacizumab (B), filgrastim (F), epoetin (E), infliximab (I), pegfilgrastim (P), rituximab (R), and trastuzumab (T).

The survey had a 31% response rate and, after adjusting for duplication, researchers had 50 unique surveys with 21 responses (42%) from NCI-designated comprehensive cancer centers.

"Inpatient formulary decisions were driven by acquisition cost followed by reimbursement," the authors reported. "In the outpatient setting, equal consideration was given to acquisition cost and reimbursement for formulary decisions. Thirty-two percent of institutions restricted biosimilars to their FDA-approved indication. Sixty-six percent of institutions had a biosimilar interchangeability policy in place."

Overall average utilization of biosimilars was 74% for bevacizumab, 88% for filgrastim, 82% for epoetin, 57% for infliximab, 52% for pegfilgrastim, 73% for rituximab and 71% for trastuzumab. The authors pointed out that more than 90% of institutions had a preferred biosimilar on formulary.

"Based on the results, 72% stated payors specified the selection of biosimilars, and 76% stated payor reimbursement limited ability to participate in contract pricing," the study noted. "Insurance reimbursement was recognized as the main barrier to adoption."

The researchers advised that medication errors related to biosimilar use were reported by 26% of respondents, with lack of communication listed as the most common cause. More than one-third (36%) of institutions provided education on the general use of biosimilars, and 38% had biosimilar products in treatment-specific education.

"Biosimilar adoption is consistent across responding institutions, with noted utilization shift towards biosimilar products compared to reference," the authors concluded. "Decisions for biosimilar adoption are made based on cost and reimbursement. Opportunities exist in the collaboration of health systems and payors to align formularies and promote safe and cost-effective care for their members."

In addition to insurance coverage, the most cited barriers to biosimilar adoption were listed as 24% for drug availability and computerized provider order entry, while 22% listed provider acceptance issues. Interestingly, patient acceptance was considered a barrier by only 8% of the respondents.

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