Biosimilar use in medical oncology in Ireland: a missed opportunity to mitigate financial toxicity?

The introduction of biologics marked a paradigm shift in the treatment of numerous life threatening and life limiting diseases such as cancer. Addressing cost effectiveness in medical oncology is necessary as cancer cases are expected to increase globally by nearly 60% in the next decade which will place an increasing demand on effective drug options. Biologic drugs carry a significant financial burden which could be alleviated with the increased use of biosimilars without compromising on quality, safety, or efficacy. Global spending on cancer drugs is expected to rise from $223 billion in 2023 to $409 billion in 2028 which is largely driven by the authorisation of novel biologic drugs. The cost of cancer drugs in Irish hospitals surged from €4.7 million in 2013 to €151 million in 2022-a gain exceeding 3,100%. The Irish Health Service Executive reported a low uptake of biosimilars with usage varying widely between hospitals. Barriers to the use of biosimilars included resistance to substitution at the community pharmacy level, and introduction of subcutaneous biologics that extend patent protection. In conclusion there remains significant potential to improve biosimilar adoption rates in Ireland which would allow both increased patient access and treatment equity. Thus, this commentary explores the use of biosimilars to address this financial burden in medical oncology and increase access to biologic cancer drugs.