Survey: Rheumatologists Still Reluctant to Switch Patients to Biosimilars

Cardinal Health recently conducted a survey of more than 100 rheumatologists asking their feelings about biosimilars, and the findings revealed that the majority of them were familiar with and comfortable prescribing biosimilars. 

Gordon Lam, M.D., FACR, rheumatologist and medical director of clinical and translational research with Atrium Health in Charlotte, NC, notes rheumatologists want greater access to treatment for their patients and lower costs, which is why 90% of those surveyed were in favor of biosimilars.

“Today, biologic drugs account for 40% of all U.S. drug costs, but only 2% of all prescriptions,” he says. “Rheumatologists believe that wider availability of biosimilars will increase competition and drive down costs across the market, which would ultimately expand access for patients.”

Industry experts have predicted that biosimilars could save up to $54 million in drug spending by 2021. The benefit for patients is key, which is why 64% of the surveyed providers said cost savings for patients was “very important” or “extremely important.”

However, a majority of rheumatologists surveyed still indicated they are reluctant to switch from reference products to biosimilars, at least partly because they don’t believe there is enough of a cost savings. In fact, only 11% of the rheumatologists surveyed said they were likely to prescribe a biosimilar to a patient who is having success on a reference product today — and the lack of a significant cost benefit appears to be a key reason. 

“Most biosimilars on the market today are priced at only a 15%-40% discount of the reference product list price, and 66% of our survey respondents said those economics were not favorable enough to motivate them to switch,” Lam says. “This may be because they fear the majority of the discount will go to pharmacy benefit managers and payers, not to patients and practices.”

Additionally, 66% of rheumatologists said they are unlikely to switch to biosimilars until there is more payer adoption. Today, more than 40%t of payers have no policies for mandatory conversion to biosimilars.

The survey also showed that concerns about biosimilars and whether they are, in fact, similar enough to their reference products.

“More than a third of our survey respondents (38%) said doubts about efficacy was their top concern about biosimilars, and 45% said they had concerns about interchangeability and extrapolation for other indications when it came to the FDA approval process.” 

He notes many rheumatologists also feel some disappointment that biosimilars are not as easy to access or as cost-effective as they would have hoped by 2020.

At this time, the two biosimilars prescribed most often by rheumatologists are Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda), which have Remicade (infliximab) as their reference product. 

In the future, Lam expects to see the growing use of Ruxience (rituximab-pvvr) and Truxima (rituximab-abbs), biosimilars to Rituxan (rituximab) biosimilars, both of which are relatively new to the market.

“Many rheumatologists are eager to access biosimilars that have been approved for two other leading rheumatoid arthritis drugs—Enbrel (etanercept) and Humira (adalimumab),” Lam says. “To date, these products have not come to market yet due to delays resulting from patent litigation with the manufacturers of the reference products. There is also optimism that biosimilars will be developed for the branded biologics that are currently used to treat other rheumatic diseases, like lupus and gout.”

While many rheumatologists are frustrated that the promise of cost savings through biosimilars has not yet been fulfilled, there are signs that the tide is starting to turn. Lam notes education about biosimilars has led to greater understanding and acceptance of the efficacy and safety of these agents among both physicians and patients.

“Legislation has been proposed to increase the transparency of biologic patents, which may curb litigation that delays the entry of biosimilar competitors once they are approved,” he says. “In addition, regulations that target anti-competitive practices of exclusionary contracts may free the forces of supply and demand, thereby increasing access and lowering costs.”

Meanwhile, the net price of some reference products has fallen over the past few years.

The price drop helps with healthcare costs — which is the whole point of biosimilars—although it has the effect of reducing the appeal of biosimilars and may, ultimately, lead to a less competitive market because biosimilars can’t gain a foothold in the market. The sales price of Janssen’s Remicade has fallen by an annual average of 14.4% since the introduction of its biosimilar competitors.