Most rheumatologists ‘unlikely’ to switch to biosimilars until greater uptake by payers

February 23, 2022

4 minute read


Disclosures: The researchers do not report any relevant financial information.

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Although an overwhelming majority of rheumatologists said they were comfortable and familiar with biosimilars, 65% said they were “unlikely” to switch their patients to reference products until be greater adoption by payers, according to the data.

In a new report on trends in biosimilar use in 2022 published by multinational health services company Cardinal Health, 98% of rheumatologists surveyed said they were somewhat or very knowledgeable about biosimilars, while 90% were said they were somewhat or very comfortable prescribing biosimilars. However, most seem reluctant to use biosimilars, with less than half saying they are likely to prescribe them to a new patient. Additionally, 65% agreed or strongly agreed that the “current economics of biosimilars” are not favorable enough to motivate them to abandon the reference product.

Although an overwhelming majority of rheumatologists said they were comfortable and familiar with biosimilars, 65% said they were “unlikely” to switch their patients to reference products until be greater uptake by payers, according to data from Cardinal Health’s 2022 Biosimilars Report: The American Journey and The Way Ahead.

“The concerns of rheumatologists about adopting the paymaster are valid,” Gordon Lam, MD, FACR, the medical director of clinical research at Arthritis & Osteoporosis Consultants of the Carolinas, in Charlotte, North Carolina, told Healio. “As research has shown, payer formulary decisions can have a substantial impact on treatment decisions.

“At the time of the survey, payer coverage of biosimilars in rheumatology was lagging,” he added. “While we have seen payer coverage increase over the past 2 years, there is still considerable variation in payer policies for product preferences, and usage management strategies such as pre-approval and staged changes have continued to slow adoption among some vendors.”

Gordon Lam

Lam, who contributed writing to the report, added that rheumatologists are also skeptical of the efficacy and promise of cost savings from biosimilars. In his written comments, he said these concerns were unsurprising, given little real evidence of their profitability in the United States. Meanwhile, the prices of the most widely used rheumatology biosimilars are only 20-35% below the list price of the reference product.

“Furthermore, many suppliers fear that the majority of economic benefits will go to [pharmacy benefit managers (PBMs)] and payers, not to patients and practices,” Lam wrote.

The survey says

Cardinal Health surveyed a total of 102 rheumatologists in February and March 2020 via an online questionnaire, according to the report. The resulting data was part of a larger effort that also combined responses from more than 320 oncologists, 100 retina specialists, 50 physicians who treat diabetes and 115 pharmacists on current trends in biosimilar use.

According to the report, 38% of rheumatologists surveyed cited efficacy as their “top concern” in prescribing biosimilars, followed by lack of economic benefit and questions about when to use a biosimilar versus a biosimilar product. reference – each cited by 21%.

About 64% of rheumatologists said the cost savings for patients were very important or extremely important when considering biosimilars as a treatment option. Meanwhile, 53% said “the favorable economy for my practice” was very important or extremely important when considering biosimilars.

More than two-thirds of participating rheumatologists agreed or strongly agreed that “the current biosimilar economics” is a barrier to biosimilar adoption, while an equal percentage agreed or strongly disagreed. agreement that they were unlikely to switch their patients to reference products until there was greater uptake of biosimilars among payers.

“The efficacy issue reflects the lack of experience in using biosimilars,” Lam said in an interview. “Research in other therapeutic areas like oncology shows that provider hesitancy is common when biosimilars are first introduced, but concerns tend to diminish significantly once physicians have first-hand experience of the drug. use of biosimilars I expect we will see the same trend in rheumatology as experience with these therapies grows.

According to Lam, education of doctors and patients has reduced skepticism about the safety and efficacy of biosimilars, while legislation has been proposed to improve the transparency of biologic patents.

Additionally, despite sluggish biosimilar sales to date in the United States, the net price of some reference products has declined in recent years. According to Lam, the selling price of Remicade (infliximab, Janssen) has decreased by an average of 19% per year since January 2018. Moreover, the market share of biosimilars in rheumatology has steadily increased to 32%, writes -he.

“Although slower than expected, the needle gradually begins to move,” Lam wrote. “It will take time to overcome these hurdles, but as they are, the value of biosimilars can be appreciated beyond simply reducing prices. By doing so, use will increase and the promise of biosimilars could be fulfilled.

Humira biosimilars are coming (finally): does it matter?

The results of Cardinal Health’s investigation come a year before a wave of biosimilars to AbbVie’s lead drug, Humira (adalimumab), would enter the U.S. market, following years of legal wrangling over patents and Royalties. At least six FDA-approved Humira biosimilars are now cleared for release in 2023 in the United States. Amjevita (Amgen, adalimumab-atto) is expected to be the first, with a regulation-mandated launch date of no earlier than January 31.

Unless delayed, that date will mark the end of AbbVie’s exclusivity on the world’s most profitable drug, a product that brought the company $16 billion in U.S. revenue and $19.8 billion in worldwide revenues in 2020 alone.

However, all of this will be for naught if uptake of biosimilars remains lackluster and concerns about efficacy and cost savings remain high. According to Lam, much will depend on the experience of the supplier and the price of the biosimilars.

“While it is uncertain how payers will react to the Humira biosimilars expected to launch next year, it is reasonable to expect that we could see similar hesitation from providers in the area of immunology as these products come to market,” Lam said. “How comfortable they are with using these treatments will always depend on increasing the total experience of providers using biosimilars.

“With respect to payer coverage, if adalimumab biosimilars are offered at a significantly reduced price compared to the reference product, it is likely that we will see an increase in payer uptake,” he said. -he adds. “In this case, rheumatologist concerns about payer coverage may become a moot point, but that remains to be seen.”

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