Proliferation of Biosimilars Could Be Costly for Oncologists, Warns Texas Oncology Policy Leader

The proliferation of biosimilars could be costly for oncologists if each insurer dictates its own biosimilar, according to a leader of one of the larger independent oncology groups in the country.

“It is unrealistic to think you can keep multiple biosimilars of one innovator product in inventory and manage that inventory at a low cost,” Debra Patt, M.D., Ph.D., MBA, said during a talk she gave last week at the 9th annual Patient-Centered Oncology Care® conference, sponsored by the American Journal of Managed Care.®

Patt, a breast cancer specialist in Austin, Texas, is the executive vice president for policy and strategic initiatives for Texas Oncology, a private practice group with about 500 physicians.

Debra Patt, M.D., Ph.D., MBA

In a wide-ranging talk that touched upon many current topics in cancer care and healthcare policies and politics, Patt said that biosimilars are “incredibly important” and a “reasonable switch” from brand-name innovator products. But she said that “frequently, insurance companies will have a ‘flavor of a month’ biosimilar.”

“If you have eight biosimilars (for an innovator product), you can’t have different insurers dictating that you use different biosimilars because these are very expensive drugs, even if they are lower cost than the innovator product,” Patt said.

Patt said costs would be lower if insurers were to embrace biosimilar choices and “weren’t so directive as to which one.”

Other topics

Patt began her talk on optimistic note, saying that this “unprecedented time of progress in cancer care.” Between 30% and 40% of patients with advanced cancer are receiving targeted therapy, she said, and 25 different types of cancer are now treated with immunotherapy.

Many of the specifics of President Donald Trump’s recent executive order that would peg Part B and Part D drug prices to prices paid in other countries are prices unknown, Patt said. However, Patt said that there are earlier indications that prices would be benchmarked to an average of prices paid in Organisation for Economic Co-operation and Development (OECD) countries with some an adjustment for gross domestic product per capita.

“But exactly how that will be delineated, which drugs will be included, is unclear at this time, so we are light on the details,” cautioned Patt, adding that it is unknown when the program will be implemented, which drugs will be included, and how large the pilot will be.

Patt also discussed alternative payment models. She said the first three performance periods of the Oncology Care Model, a CMS value-based care arrangement, hadn’t shown tremendous savings, but that she thought the “jury was still out” on the model. She also noted the great interest that commercial payers have in alternative payment arrangements.

“My practice alone has five alternative payment pilots with commercial payers, and they mirror many aspects of the Oncology Care Model, so as we try to make the walk from volume to value in oncology, I think alternative payment models are a really important way to do that,” Patt said.