LaunchTrends: Zarxio (Wave 2) is the second in a series of syndicated reports designed to track physician perception and uptake of Sandoz’s Zarxio (filgrastim-sndz), a biosimilar of Amgen’s Neupogen and the first biosimilar to launch in the United States.

The study surveys medical oncologists and hematology-oncologists in the United States and assesses the formulary coverage and restrictions associated with Zarxio and other products in the granulocyte colony-stimulating factor (G-CSF) class. These reports evaluate physicians’ awareness and perception of Zarxio, uptake of the biosimilar over time, Zarxio's effect on other G-CSFs, and promotional activity related to Zarxio and other G-CSF products.

Questions Answered:

  • Zarxio launched in the United States in September 2015. Are U.S. oncologists aware of the biosimilar and of how it was tested during clinical development?
  • Biosimilars are intended to share the clinical profile of the reference brand; therefore, a clinical benefit over the brand is not expected to be associated with their use. Why have physicians chosen to prescribe Zarxio or an alternative G-CSF?
  • Pharmacists in the United States are not permitted to substitute the reference brand Neupogen for Zarxio, because Zarxio was approved as a biosimilar, not an interchangeable biological product; thus, physicians must directly prescribe Zarxio for their patients to receive it. What promotional messages are sales representatives using for Zarxio and other G-CSF brands to influence physician prescribing?
  • Zarxio is the first biosimilar to launch in the United States. As such, the industry has no prior experience of how managed care organizations will incorporate Zarxio into formularies. Which formulary tier and what restrictions, if any, are being applied to Zarxio, and how does it compare with other G-CSFs?

Table of contents

  • Biosimilars - Emerging Biosimilars - Oncology: Zarxio Launch Tracking (US) Wave 2
    • Key Findings
      • Zarxio Awareness and Promotional Activity for G-CSFs
      • Who Is the Zarxio Prescriber?
      • Significant Differences Between Zarxio Prescribers and Nonprescribers
      • Who Is the Zarxio Patient?
      • Zarxio-Treated Patients by Indication
      • Trends in Zarxio Uptake
      • Patient Share of Filgrastim Products
      • Patient Share of Filgrastim Products by Practice Type
      • Quarterly U.S. Sales of Short-Acting G-CSFs
    • Benchmarking Zarxio Launch Success versus Other New Products
      • Key Findings
    • Formulary Analysis
      • Introduction
      • U.S. Payer-Reported Coverage of G-CSFs
      • Zarxio Formulary Coverage Compared with Neupogen
      • Zarxio Commercial and Medicare Coverage Compared with Neupogen
      • Granix Formulary Coverage Compared with Neupogen
      • Granix Commercial and Medicare Coverage Compared with Neupogen
      • Changes in Formulary Status of G-CSFs
      • Changes in Formulary Status March 2015-March 2016: Commercial
      • Changes in Formulary Status March 2015-March 2016: Medicare
    • Zarxio Awareness and Perceptions
      • Unaided Awareness of Biologics for Treatment/Prevention of Chemotherapy-Induced Neutropenia
      • Biologics Recalled for Chemotherapy-Induced Neutropenia
      • Biologics Recalled by Order of Response
      • Level of Familiarity with Biosimilars and Zarxio
      • Level of Familiarity with Biosimilars
      • Level of Familiarity with Zarxio
      • Physician Perception of Indications in Which Zarxio Was Studied
      • Indications in Which Physicians Believe Zarxio Was Clinically Studied Prior to Approval
      • Physician Perception of Zarxio’s Approved Indications
      • Indications Physicians Believe Zarxio is Approved to Treat
      • Information on Zarxio’s Development
      • Clinical Trial Information for Zarxio
      • Physician Perception of Indications Zarxio Should Be Approved to Treat
      • Indications Physicians Believe Zarxio Should Be Approved to Treat
    • Zarxio Trial and Use
      • Patients Prescribed Zarxio
        • Prescription of Zarxio: Patients Receiving Myelosuppressive Chemotherapy
        • Number of Cancer Patients Receiving Myelosuppressive Chemotherapy Prescribed Zarxio
        • Prescription of Zarxio: Other Hematology-Oncology Patients
        • Number of Hematology-Oncology Patients Prescribed Zarxio
        • Healthcare Coverage of Zarxio-Treated Patients
        • Healthcare Coverage for Patients Treated with Zarxio
        • Healthcare Coverage for Neutropenia Patients
        • Drug Benefit Coverage for Neutropenia Patients
        • Prevalence of Treatment Switching to Zarxio or Use of Zarxio in Treatment-Naive Patients
        • Proportion of Zarxio-Treated Patients Who Were G-CSF-Naïve or Switched from Another G-CSF
        • Current G-CSF Patient Share
        • Current Patient Share of G-CSFs Among Zarxio Prescribers and Nonprescribers
        • Current Patient Share of Long- and Short-Acting G-CSFs by Prescriber Status
      • Prescribers' Experience of Zarxio
        • Prescription of Zarxio: Any Indication
        • Proportion of Oncologists Who Have Prescribed Zarxio to at Least One Patient
        • Reasons for Prescribing Zarxio
        • Reasons for Choosing to Prescribe Zarxio
        • Perceived Similarity Between Zarxio and Neupogen
        • Prescribers' Perception of Zarxio’s Similarity to Neupogen
        • Reported Differences Between Zarxio and Neupogen
        • Satisfaction with Zarxio
        • Overall Level of Satisfaction with Zarxio
        • Perceived Cost of Zarxio
        • Perceived Discount of Zarxio Compared with Neupogen Net Cost
        • Filgrastim Pricing and Medicare Part B Reimbursement
        • WAC and Medicare Part B Payment Limit
      • Reasons for Not Prescribing Zarxio
        • Oncologists' Reasons for Not Prescribing Zarxio
        • Reported Responses for Not Prescribing Zarxio
    • External Factors Affecting Use
      • Factors That Could Increase Use of Zarxio
      • Factors That Would Encourage Use or Increase Use of Zarxio
      • Sources of Pressure or Recommendations to Use Zarxio
      • Sources of Pressure for the Use of Zarxio Instead of Other G-CSF Brands
      • Predicted Uptake of Zarxio by Healthcare Coverage
      • Predicted Variability in Zarxio Uptake Depending on Patients’ Healthcare Coverage
      • Reasons for Rapid Uptake of Zarxio
      • Rate of Acceptance of Zarxio by Patients
      • Percentage of Patients Who Accepted Zarxio When Proposed
      • Opinions on Nonproprietary Names for Biosimilars
      • Oncologists' Opinions on Nonproprietary Names for Biosimilars
    • Promotional Activity
      • Most Recent Contact with Sales Representatives
      • Most Recent Contact with Medical Sales Representatives for Zarxio and Competitors
      • Topics of Discussion with Medical Representatives
      • Topics Discussed with Medical Representatives
    • Future Use of Biosimilars
      • Zarxio's Influence on Willingness to Use Other Biosimilars
        • Likelihood of Prescribing Other Biosimilars: Medical Oncologists
        • Likelihood of Prescribing Other Biosimilars as a Result of Zarxio Use: Medical Oncologists
        • Likelihood of Prescribing Other Biosimilars: Hematology Oncologists
        • Likelihood of Prescribing Other Biosimilars as a Result of Zarxio Use: Hematology-Oncologists
      • Likelihood of Prescribing Different Filgrastim Biosimilars
        • Likelihood of Prescribing Other Filgrastim Biosimilars
      • Future Patient Share Expectations for G-CSFs
        • Future Patient Share of G-CSFs: Pegfilgrastim Biosimilars Unavailable
        • Future G-CSF Patient Share: Medical Oncologists
        • Future G-CSF Patient Share: Hematology-Oncologists
        • Future Patient Share of G-CSFs: Pegfilgrastim Biosimilars Available
        • Future G-CSF Patient Share if Pegfilgrastim Biosimilars Are Available
        • Future Patient Share of G-CSFs Among Zarxio Prescribers and Nonprescribers
        • Future Patient Share of Long- and Short-Acting G-CSF by Prescriber Status
        • Future Patient Share of G-CSF Biosimilars Among Zarxio Prescribers and Nonprescribers
        • Future Patient Share of Long- and Short-Acting G-CSF Biosimilars by Prescriber Status
    • Appendix
      • Background on the U.S. G-CSF Market
        • Overview
        • Short-Acting G-CSFs
        • Product Information: Short-Acting G-CSFs
        • Long-Acting G-CSFs
        • Product Information: Long-Acting G-CSFs
        • Approved Indications for G-CSFs in the United States
        • G-CSF Market News
        • Assumptions Supporting Launch Date Estimates for Future G-CSF Biosimilars
        • Launch Date Estimates for Future G-CSF Biosimilars
      • Methodology and Objectives
        • Objectives
        • Methodology
        • Significance Testing
        • Significance Testing in This Study
      • Respondent Demographics
        • Practice Location of Oncologists
        • Respondents' Practice Location
        • Regional Location of Oncologists
        • Distribution of Respondents by Region
        • Years in Clinical Practice and Practice Type
        • Years in Clinical Practice
        • Practice Type
        • Patients Under Management: Medical Oncologists
        • Number of Patients Receiving Myelosuppressive Chemotherapy Managed Per Month
        • Patients Under Management: Hematology-Oncologists
        • Number of Adult Cancer Patients Under Management Per Month
        • Number of Pediatric Cancer Patients Under Management Per Month
        • Prescribed Drugs: Medical Oncologists
        • Drugs Prescribed by Medical Oncologists
        • Prescribed Drugs: Hematology-Oncologists
        • Drugs Prescribed by Hematology-Oncologists

Author(s): Marta Delgado

Marta Delgado, Ph.D. is a Business Insight Analyst in the Biosimilars Research team, responsible for the analysis of the biosimilars market across four main therapeutic areas – oncology, endocrinology, immunology and nephrology. Marta holds a Ph.D. in Molecular Neuroscience from University College of London (UCL) and a B.Sc. in Biomedicine from University Pompeu Fabra (UPF), Barcelona. Prior to joining the Biosimilars Research team, Marta worked as a Research Analyst at SKIM, specialising in advanced quantitative studies assessing the potential market opportunities to support life sciences companies in their business decision making.


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