Expert: Biosimilars and Generics Lower Cost of Cancer Care

Pharmacy Times® interviewed Clayton Irvine, PharmD, MBA, MS, senior manager, oncology cancer care at Mayo Clinic, about the cost of cancer care. Irvine discussed how advancements in health care technology can contribute to the overall costs for cancer care, and that biosimilar or generic treatments can be helpful for lowering costs; however, it is difficult for health systems to quickly implement these products on such a large scale. He also emphasized the significance of transparency, notably around drug pricing and rebates, when it comes to pharmacy benefit manager (PBM) activity.

Irvine was one of several panelist speakers at the discussion “The Cost of Cancer Care,” part of the event “Elevating Cancer Care Delivery: Thinking Outside the Box.” The event, which was cohosted by Institute for Value Based Medicine® (IVBM) and Mayo Clinic, created a unique forum where experts discussed their experiences and insights on the implementation of value-based care that is relevant for both oncology and population health stakeholders.

Pharmacy Times: What are some key drivers impacting the cost of cancer treatment looking toward 2025, in your view?

Clayton Irvine, PharmD, MBA, MS: I think [that] when we think about what's contributing to rising costs, you have an aging population, a more vulnerable patient population, our patients are living longer—which is great—but our patients are also getting a lot sicker and there's a lot more comorbidities and different diseases that all have to be managed beyond just what you see from the cancer perspective. One thing that's really great in what we're seeing is there's exponential advances in technology and diagnostic testing, which is great, but those are also contributing to the cost that we see. We also just see higher inflation across the health care landscape as a whole, and that is also contributing to the increased costs that we see each and every day.

Pharmacy Times: What is your outlook on the biosimilar market and its sustainability in oncology, as well as its ability to impact the cost of cancer care for patients and health systems?

Irvine: I think what we're seeing with biosimilars [has] been great. The access to treatments are great, we are seeing cost coming down; however there's a lot of barriers with health systems being able to quickly adopt and implement these. There's a lot of payer restrictions and payer directives that drive certain practices or certain use of certain agents, and so, there's definitely those barriers. Health systems have to come up with ways to be more adaptable and to be able to adopt these products on a much larger and quicker scale than what we've historically been able to do. From a sustainability standpoint, there's a lot of uncertainty around the biosimilar market for a lot of different reasons.

But in the long run, I do think having more agents to lower costs is ultimately a good thing, and I am very optimistic for the future of the sustainability of the biosimilar market.

Pharmacy Times: What is your outlook on the legislation looking to curtail PBM activity, and how might this impact the cost of cancer care?

Irvine: I think as we start to think about different strategies and things that are being done, that increased transparency is going to be key. I do feel that as there's more pressure as state legislation...we've seen some action from the Federal Trade Commission, [and] as we continue to put pressure on PBMs for increased transparency around rebates and drug pricing, I'm optimistic that these strategies are really going to help lower the overall cost of care. This isn't going to be something that we see overnight, but I do think from an outlook perspective, we're on the right track, and I think that conversations have already started, and I think there's great momentum. As health care providers, as clinicians, we have the ability to continue to drive that narrative forward, continue to educate, be involved with local advocacy and policy efforts, [and] really be that voice because by being that voice, we're advocating for our patients, and that's one of the biggest ways that we can continue to contribute in our daily practices each day.