Rheumatology nurses can play ‘unique role’ in improving biosimilar uptake
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AUSTIN, Texas — It is critical for rheumatology providers to have a thorough grasp of biosimilarity to properly respond to patient concerns regarding biosimilars, a presenter said at the 2023 Rheumatology Nurses Society annual conference.
“There are no clinically meaningful differences between a biosimilar and a reference product,” Jacqueline Fritz, RN, MSN, RN-BC, a rheumatology nurse at AOmed, based in California, told attendees on multiple occasions.
She stressed that this was one of the key messages that providers should convey to patients who have concerns about receiving these drugs.
The other message is that the increasing number of biosimilars on the market can translate into better and faster access to treatment, as the approval process for biologics can be prolonged and cumbersome.
“I tell patients I can treat you this week, not 3 months from now,” Fritz said.
One key point is that biologic medications are made from living cells, rather than from a chemical process, which makes them different from generic medications. It is for this reason that batches of biologic medications can be different from one another, and why biosimilar medications are not identical to their reference products.
“But they come from the same sources, are administered the same way, have the same strength, the same doses, the same potential treatment effects and potential side effects as the reference treatment,” Fritz said. “They pose no greater risk to the patient.”
Patients also have questions about interchangeability — another emerging front in rheumatology treatment.
“An interchangeable biosimilar may be substituted for the reference product without consulting the physician, depending on the state,” Fritz said.
Although this type of switching can raise questions from patients — and cause difficulties for the doctor-patient relationship — Fritz stressed that for a product to be deemed interchangeable, the pharmaceutical company must put the medication through “rigorous evaluation,” in addition to the process that determines biosimilarity.
“They can provide significant benefits because of potential cost savings to the patient, the payor and the health care system,” she said.
However, the realities of improved access and cost savings still have not come to fruition, at least in the United States, despite an influx of biosimilars recently entering the rheumatology market, largely because of structural barriers involving money, resources and the nature of the U.S. health care system.
Fritz acknowledged that reference products still commonly make more money for insurance companies. Health systems and payors, accordingly, have contracts with companies that make the originator products. Administrative lag caused by prior authorization can result.
All these factors can lead patients to still have questions, according to Fritz. They perceive a drug to be problematic when these structural issues arise. She noted a “nocebo effect,” or the worsening of symptoms triggered by a patient’s negative feelings regarding an intervention, may occur.
A companion concern is that there are some providers who refuse to prescribe biosimilars, favoring the bio-originator reference product.
“It’s a tug of war,” Fritz said. “There are some physicians who are cemented in and will not change.”
It is for this reason that rheumatology nurses are so important, she added.
“Nurses regularly rank as the most trusted group of health care providers,” Fritz said. “We play a unique role in offering essential information to our patients.”
If the nurse effectively communicates the potential positive attributes of biosimilar and interchangeable medications, patients may respond accordingly.
“It’s about how you present them to your patients,” Fritz said. “If you are uncertain, they may become afraid, and they will say they think they are more tired or have more of a headache.”
A final concern is that patients can get their information from sources outside of the clinic. Again, rheumatology nurses can head off misinformation and move the ball forward for biosimilar uptake.
“Patients either learn from the television or they learn from you,” Fritz said. “Our job is to teach them properly.”
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Fritz J. RNS Dinner Series | Handling the Hard Questions: What Our Patients are Asking Us About Biosimilars. Presented at: Rheumatology Nurses Society annual conference; August 2-5, 2023 (hybrid meeting).
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