A few days ago, I published an article highlighting the diverse efforts four different patient advocacy groups have undertaken to educate their members about biosimilars. However, what stood out to me was that none of these four groups in the panel at the Biosimilar Council’s 2017 Leading on Biosimilar conference mentioned working in partnership with a biosimilar company or companies — though they all expressed their desire to work more closely with the industry. In fact, I’ve rarely seen instances in which biosimilar companies and patient organizations have linked-up in an official capacity to address biosimilar education. As such, I was thrilled to hear this panel’s moderator pose what I consider to be two separate, but equally important, “million-dollar questions:” What do patient groups want from biosimilar manufacturers, and what advice can they give companies to help shape their initiatives to educate stakeholders?
Establishing A Contract With Patients: Does Brand Loyalty Matter?
A conversation often had at biosimilar conferences is about the relationship patients have with brand medications. Indeed, one of the most important criteria for a biosimilar company, in addition to getting the science right, is ensuring the drug offers the necessary patient assistance program. The patient advocacy groups represented at the Leading on Biosimilars conference — the Crohns & Colitis Foundation, CancerCare, Black Women’s Health Imperative, and the Cancer Support Community — acknowledged biosimilar companies are on-the-ball when it comes to these patient benefits. Companies know patients need these programs and have established them.
But this conversation also raised the question: what role does brand loyalty to the innovator truly play for patients should the time come to switch to a biosimilar? After all, many of the innovators have emphasized patients’ and physicians’ trust in and positive experiences with the reference drug — especially following the launch of the first few biosimilars on the U.S. market. Similarly, given the currently minimal discounts for the biosimilars on the U.S. market today, there also may not be as much financial incentive. As Claire Saxton, the senior director of education and outreach for Cancer Support Community, described, there are some instances in which the biosimilar could even be a more expensive option — especially should the reference product have copay assistance and the biosimilar not.
But Dr. Christy Gamble, director of health policy and legislative affairs for Black Women’s Health Imperative, pointed out, patients ultimately trust their doctor and take their advice. “When we’re talking about brand loyalty, I think it’s primarily referring to the physician’s relationship with the brand.” She referenced a study demonstrating patient hesitance to take the biosimilar, but also highlighted the fact that over 80 percent of these patients’ doctors wrote prescriptions for the innovator rather than the biosimilar. To me, this exemplifies the trust patients have in their doctor’s therapeutic advice. As such, overcoming “brand loyalty” is solved by the education of providers, which, Gamble emphasized, is particularly welcome to populations of color (POC). “We’re looking to know that our provider has our best interest in mind and that they’re going to say, ‘Look, your insurance company does not cover this biologic. Let’s talk about going to the biosimilar,’” said Gamble.
Laura Wingate, SVP of education, support, and advocacy for the Crohn’s & Colitis Foundation, agreed it’s less about brand loyalty for patients and providers, and more about demonstrating safety and efficacy. The challenge is ensuring patients have the tools to be well-educated and that these tools are catered to different learning styles and methods. “It’s not just a one-size-fits-all approach to education,” Wingate described, “It has to be driven by the various ways people learn.”
What Do Patient Groups Want From Biosimilar Companies?
A priority for Gamble at the Black Women’s Health Initiative is ensuring affordability and accessibility become synonymous for POC. As such, a big concern is ensuring the industry is doing all it can to make biosimilars widely available in retail pharmacies — including mail-order pharmacies.
Obviously, ensuring access through retail and mail-order pharmacies will involve skillful collaboration and negotiation between biosimilar companies and pharmacy benefits managers in order to get biosimilars placed on formularies. But as Wingate from the Crohn’s and Colitis Foundation argued, these negotiations should include the patient’s voice as well, and companies are in a prime position to help patient groups connect with payers.
“PBMS and payers are players that are really important here, but they aren’t often working with nonprofits in the realm of education,” she explained. “Access and affordability are big issues, and it’s going to take all of us working together. If there’s a way for the biosimilar industry to help open those doors as you’re entering the market and having these discussions with payers, it would be a value-add to bring us to the table as well.”
In addition to mail-order pharmacies and payers, Saxton from the Cancer Support Community pointed out two other stakeholders — financial counselors and social workers — that have been particularly valuable resources for patients within her organization. As I described above, one caveat with the biosimilar pricing and reimbursement landscape right now is the possibility that biosimilars will not actually end up being cheaper than the brand drug. As such, Saxton pointed out, in some cases, patients may rely on financial counselors in addition to their clinics when incorporating treatments into their budgets.
Similarly, seeing as the Cancer Support Network provides social workers to help patients navigate the complexities of their illness, Saxton also emphasized the importance of paying attention to these stakeholders. “Though our social workers would never provide medical information to patients, it helps for them to be taught the differences between biosimilars and generics so that when these treatments become more common in the oncology space, they can ensure patients know there are multiple treatment options available,” said Saxton.
Ultimately, a key takeaway I gleaned from listening to these representatives is for manufacturers to be attuned to the people — or touch points — within each individual patient organization —just as much as focusing on the patients themselves. In the past, I’ve seen charts of the many stakeholders in the biosimilar space. But in order to accomplish the overarching goal of educating patient advocacy groups, it would likely prove valuable to determine the other parties within that patient organization that patients rely on for information on managing treatment costs, side effects, and the day-to-day process of remaining adherent to their medications.
How Can Manufacturers Educate Patients And Physicians?
Though it’s easy to argue biosimilar companies should establish partnerships with patient organizations and leave it at that, there are countless ways in which to do this. One way highlighted in particular by these patient organizations was through funding. For instance, several experts shared that they require grant assistance for putting together webinars, publications, and other education strategies for their members. But in addition to the creation of these resources, patient advocacy groups often need help distributing them. There are many stakeholders at clinics, hospitals, nursing associations, and other trade groups that patient organizations (and biosimilar companies, for that matter) need and want to educate. “Sometimes the industry is able to provide a grant to help develop a piece and is also able to help distribute it,” Saxton clarified. “This would be a fantastic way to increase our multichannel distribution.”
In addition to partnering with organizations and providing a diverse array of educational materials, there are a number of creative ways companies and patient organizations can illustrate the “similarity” of a biosimilar that don’t include dry, in-the-weeds discussions of molecules. For instance, given the nation’s interest in craft beers and distilleries, I’ve often heard patient advocates and members of the FDA compare the process of making a biosimilar to that of making wine and beer.
And that’s just the start of the creative approaches companies and advocacy groups could explore. In fact, the artistic side of me would like to argue in favor of using the performing arts, which hold a lot of untapped scientific education potential. For example, in a fabulous twist of fate, I recently stumbled upon the announcement of this year’s winners of Science magazine’s “Dance Your Ph.D. Contest.” This year’s winners found ways to use silk acrobatics and hula hoops to illustrate sea star ecology, braid theory in topology, and the biochemistry of criminal forensics. If the biosimilar industry does nothing with this information, I will be sorely disappointed.