Biosimilar therapeutic exchange processes can reduce the high cost of cancer drugs.
Oncology had a pivotal moment with the first FDA approval of a biosimilar for supportive care in 2015, bringing an alternative therapy to a costly innovative drug to the fore. This was followed by the approval of biosimilars for primary therapy in 2019. Since then, a large number of biosimilar oncology treatments have emerged, challenging providers to keep up with the growing body of science that comes with each new development.
As a result, healthcare providers have increasingly turned to oncology-trained pharmacists to gain a critical understanding of emerging new agents on the market. As this increased reliance on pharmacists emerges, the pharmacist has become even more important as a trusted advisor to medical oncologists and the healthcare team. Because of this shift, pharmacists have supported increased use of biosimilars as their suppliers feel comfortable using these new agents.
As the cost of cancer drugs continues to rise, many practices are leveraging biosimilar therapeutic exchange (TI) processes as a way to lower healthcare costs, enabling success in value-based delivery models. Given the deep expertise of oncology pharmacists, they are well positioned to play a leading role in developing and managing these fast-growing TI programs.
Pharmacists are essential to TI .’s success
Traditional distribution activities are still the core function of the work of pharmacists specifically trained in oncology, as they oversee the safe procurement and preparation of specialized oncology drugs prior to administration to the patient. In addition, these pharmacists assist the healthcare team in the complex selection of drugs, the monitoring of side effects and the treatment of side effects. In many organizations, pharmacists are also taking on an even greater role in developing and managing TI programs, making them an essential member of the practice.
TI processes are best directed by pharmacists, as they are highly adept at navigating the complicated decision-making process of selecting drugs in the same category with similar therapeutic indications. Furthermore, handling biosimilars of similar nomenclature has introduced the risk of medication-related safety events due to misreading, and pharmacists participating in this workflow can help reduce these types of errors. It has become a necessary investment that every healthcare team must make to improve patient care. These clinically trained specialists assess and ensure the safe use of biosimilars.
A critical first step in setting up a TI program is to establish a Pharmacy and Therapeutic Committee (P&T). The P&T Committee acts as the provider’s governing body, providing a framework that gives pharmacists greater autonomy to make changes and ensure physicians agree to TI processes. Pharmacists tend to support most P&T committees and play a critical role in collecting clinical and cost data on the drugs to inform decision makers in choosing a drug of choice.
TI programs offer several benefits
TI programs enable practices to efficiently transition to increased use of biosimilars, providing many benefits to stakeholders, including the following:
• Patients have access to cheaper treatment options without sacrificing clinical efficacy. This is particularly facilitated by the growing number of biosimilars, increasing competition and lowering the price for patients who face rising deductibles and coinsurance costs.
• The use of biosimilars enabled by TI programs provides a foundation for practices to succeed in value-based care, as biosimilars can deliver significant cost savings over innovative products.
• TI programs can improve payer relationships as biosimilars allow practices to use medicines that are still effective, but priced lower. This provides tremendous value to payers by helping to control the cost of care.
Challenges for TI
There are obstacles that can block or slow down TI. In smaller clinics, pharmacies often focus more on the distribution channel than other initiatives. However, the emergence of new medicines, such as biosimilars, makes it essential for practices to invest in bringing pharmacists into healthcare teams. These expert specialists keep track of changes and new therapies, making it easier to adhere to agreed P&T initiatives for preferred drugs.
In addition, because providers want to remain independent, implementing a TI program can meet with resistance because it adds an extra layer of supervision. To effectively address this resistance, building trust between providers and the pharmacy is critical. Furthermore, pharmacies can implement processes and procedures that can help them overcome any setbacks.
The US Oncology Network provides remote clinical assessor services
There is still evidence of the value that oncology pharmacists add to a practice. In a recent review of chemotherapy treatment orders within a community oncology practice, researchers found that substantial benefits could be gained from using a clinical pharmacist trained in oncology.1
The researchers noted that of the documented reviews over a 10-week period, 49.2% led to pharmacist adjustments, resulting in $106,000 improvements and a $462,000 reduction in total drug health care costs.1 Based on these results, the researchers concluded that an oncology pharmacist was a cost-effective and valuable member of the healthcare team, improved regimen safety and optimization, and demonstrated significant financial impact for the practice, payers and patients.1
Unfortunately, despite the obvious benefits of having pharmacists on the healthcare team, many small community practices either don’t have pharmacists or have a small pharmacy staff with limited time to review regimens, making TI less likely. Because of this current shortage of pharmacists in smaller centers, The US Oncology Network has developed a clinical pharmacist assessment program called ClinReview, which provides pharmacy services to practices remotely.
Oncology-trained pharmacists electronically review all chemotherapy regimens and identify opportunities to tailor therapies based on clinical components, waste reduction, and responsible financial management. Practice policies dictate what changes can be made by their pharmacy staff, and other recommendations are discussed with the patient’s oncologist. The program provides a strong return on investment by optimizing drug regimens, improving drug use and safety, and lowering drug costs.
The role of the pharmacy in step-by-step operations
Many biosimilars that have been around for several years are now widely used, with some payers making their own policy decisions for these agents. However, these decisions can often pose challenges to practices by requiring step-by-step operations. When this happens, paperwork and scrutiny hamper care, while health care providers contest the arbitrary drug choice.
Pharmacists can help with these challenges by educating physicians about the changing landscape of payer drug choice and showing payers why step-by-step operations should not be followed for a particular drug. This ultimately enables the supplier to make the best decision in the cost-effective selection of drugs. By demonstrating the continued success of this process, payers can remove the practice from step-by-step editing processes.
Every healthcare team needs a pharmacist
Oncology is becoming more complex by the day, not only because of biosimilars and TI programs, but also because of the continuous evolution of new drugs and oral therapies. These agents are highly specific and target the disease and specific disease states within a cancer diagnosis.
Because of this increasing complexity, a highly knowledgeable specialist should monitor all aspects of these treatments – a role ideally suited to oncology pharmacists. These clinically trained professionals should be part of the healthcare team and have clearly defined responsibilities, enabling them to play a critical role in ensuring safe, high-quality care for patients.
About the author
jos Howell† PharmD† BCOPis vice president of pharmacy and clinical programs for the US Oncology Network.
1. Kula J, Hough S, Howell J. Impact of a pivotal oncology clinical pharmacist review in a community oncology practice. J Clin Oncol† 2020;39 (suppl. 28):68. doi:10.1200/JCO.2020.39.28_suppl.68