CN1 Patterns of Utilization and Implementation Experiences of Oncology Monoclonal Antibodies (MABS) Biosimilars in the U.S.: From BOTH Payers and Healthcare Professionals (HCPS) Perspectives


      Biosimilars are highly similar to an originator biologic, with no clinically meaningful differences in safety or efficacy. The adoption of biosimilars might provide an opportunity to lower costs and increase patient access to biologics. The current study sought to understand real-world implementation experiences associated with oncology MAbs biosimilars (trastuzumab, rituximab, and bevacizumab) from both payer and healthcare professional (HCP) perspectives.


      In-depth qualitative telephone interviews with 20 each of US HCPs (including 3 practice managers) and payers were conducted. The HCPs were either affiliated with a healthcare network or were community-based. They specialized in hematology/oncology and had experience prescribing oncology biosimilars. Participating payers included Managed Care Organizations (MCOs), Integrated Delivery Networks (IDNs) and Pharmacy Benefit Managers (PBMs). Audio transcripts of the interviews were coded using MaxQDA software.


      Over 80% of HCPs interviewed perceived biosimilars to be highly comparable to originators in efficacy and safety. About 70% of HCPs reported using biosimilars in >50% of their treatment-naïve patients and were comfortable with use of biosimilars in all approved indications. To encourage utilization, approximately 75% of MCO/PBM payers preferred biosimilars over originators in treatment-naïve patients, which was implemented through step therapy. HCP involvement in choosing a biosimilar for their patients was minimal, and biosimilars were often automatically ordered by pharmacists or administrators based on practice protocols or patients’ cost due to insurance preferences. The major factor that influenced both payers’ coverage decisions and HCP adoption of biosimilars was potential cost savings. Moreover, payers considered HCPs’ clinical confidence with biosimilars as a factor influencing their biosimilar coverage decisions.


      Both HCPs and payers in the US have favorable views of oncology MAbs biosimilars, particularly among treatment-naïve patients. A framework for biosimilars integration into oncology practice is developing, which is primarily driven by insurance coverage policy, contracting, and cost benefits.