Most rheumatologists 'unlikely' to switch to biosimilars until greater payer adoption
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Despite an overwhelming majority of rheumatologists reporting comfort and familiarity with biosimilars, 65% said they are “unlikely” to switch their patients from reference products until there is greater payer adoption, according to data.
In a new report on 2022 trends in biosimilar use released by multinational health care services company Cardinal Health, 98% of surveyed rheumatologists stated they were somewhat or very familiar with biosimilars, while 90% expressed they were somewhat or very comfortable prescribing biosimilars. However, most seem reluctant to use biosimilar products, with less than half stating they are likely to prescribe them to a new patient. In addition, 65% agreed or strongly agreed that the current “economics of biosimilars” are insufficiently favorable to motivate them to switch from the reference product.
“Rheumatologists’ concerns about payer adoption are valid,” Gordon Lam, MD, FACR, 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 rheumatology biosimilars was lagging,” he added. “Although we’ve seen payer coverage increase over the past 2 years, there is still dramatic variation in payer policies for product preferences, and utilization management strategies such as prior authorization requirements and step edits have continued to lead to slower adoption among some providers.”
Lam, who contributed a written perspective to the report, added that rheumatologists are also skeptical of biosimilars’ efficacy and promise of cost savings. In his written comments, he stated that these concerns are not surprising, given the scant real-world evidence of their cost-effectiveness in the United States. Meanwhile, the most heavily used rheumatology biosimilars are priced at only 20% to 35% below the reference product’s list price.
“In addition, many providers fear that the majority of the economic benefit will go to [pharmacy benefit managers (PBMs)] and payers, not to patients and practices,” Lam wrote.
Survey says
Cardinal Health surveyed a total of 102 rheumatologists in February and March 2020 via a web-based questionnaire, according to the report. The resulting data were part of a larger effort that also combined answers 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 reference product — each cited by 21%.
Approximately 64% of rheumatologists said cost savings for patients was very important or extremely important when considering biosimilars as a treatment option. Meanwhile, 53% reported that “favorable economics 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 “economics of biosimilars” is a barrier to adopting biosimilars, while an equal percentage agreed or strongly agreed that they were unlikely to switch their patients from reference products until there is greater adoption of biosimilars among payers.
“The efficacy concern reflects lack of experience using biosimilars,” Lam said in an interview. “Research from other therapeutic areas like oncology shows hesitancy among providers is common when biosimilars are initially introduced, but concerns tend to drop significantly once physicians gain firsthand experience using biosimilars. I expect we will see the same trend in rheumatology as experience with these therapies grow.”
According to Lam, physician and patient education have reduced skepticism regarding the safety and efficacy of biosimilars, while legislation has been proposed to improve the transparency of biologic patents.
In addition, despite lackluster sales for biosimilars to date in the United States, the net price of some reference products has fallen over recent years. According to Lam, the sale price of Remicade (infliximab, Janssen) has decreased by an average of 19% annually since January 2018. In addition, the market share of rheumatology biosimilars has steadily grown to 32%, he wrote.
“While slower than expected, the needle is gradually starting to move,” Lam wrote. “It will take time to overcome these obstacles, but as it does, the value of biosimilars may be appreciated beyond that of mere price reduction. In doing so, utilization will increase, and the promise of biosimilars may be fulfilled.”
Humira biosimilars are (finally) coming: Will it matter?
The results of the Cardinal Health survey come 1 year before a wave of biosimilars to AbbVie’s blockbuster drug Humira (adalimumab) are slated to enter the U.S. marketplace, after years of legal wrangling over patents and royalties. At least six FDA-approved Humira biosimilars are now cleared for a 2023 release in the United States. Amjevita (Amgen, adalimumab-atto) is scheduled to be the first, with a settlement-enforced launch date of no earlier than Jan. 31.
Barring any delays, that date will mark the end of AbbVie’s exclusivity over the highest-grossing drug in the world, a product that netted the company $16 billion in U.S. revenue and $19.8 billion in global revenue in 2020 alone.
However, all will be for naught if biosimilar uptake remains lackluster and concerns over efficacy and cost savings remain high. According to Lam, much will depend on provider experience and how biosimilars are priced.
“Although it is not certain how payers will respond to the Humira biosimilars expected to launch next year, it is reasonable to expect that we may see similar provider hesitance in the immunology space as these products come to market,” Lam said. “Their comfort utilizing these treatments will still depend on growing the total provider experience using biosimilars.
“As for payer coverage, if the adalimumab biosimilars are priced at a significant discount to the reference product, it is likely we’ll see increases in payer adoption,” he added. “In this case, rheumatologists’ concerns about payer coverage may become a moot point, but that remains to be seen.”
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