Inside the UK Switch to Biosimilar Adalimumab

The Biosimilars Commercialisation Summit 2019 is held under Chatham House Rules, which stipulate that speakers cannot be identified.

The United Kingdom has made no secret of the fact that it is pinning hopes of significant cost savings on a switch to biosimilar adalimumab from the reference Humira. Just a month after biosimilars became available, the UK National Health Service (NHS) announced that it had arrived at a plan whereby it will save £300 million (approximately US $386 million) of its £400 million (approximately US $514 million) annual spending on adalimumab as a result of using biosimilars.

During the Biosimilars Commercialisation Summit, held May 14-15, 2019, in Amsterdam, the Netherlands, a specialist pharmacist for a large NHS healthcare trust explained how the transition to biosimilars worked at a practical level in the UK home care system, and shared lessons learned from the experience.

In the UK setting, self-administered biologics are delivered to patients in their homes by commercial companies that are paid for by pooled funds from the pharmaceutical industry. Once a prescription is initiated by a hospital prescriber, nurses deliver the products and teach patients how to inject their therapy at home.

Having previously transitioned patients to biosimilars of other biologics, the pharmacist said that “we learned that errors do happen.” In an earlier switch from brand-name Enbrel to biosimilar etanercept, she found that some patients didn’t receive their new products, and stock control was a problem because pharmaceutical companies could not always deliver the amount of product that they had promised. As a result, some patients had their etanercept rationed. Additionally, home care nurses could not cope adequately with the “mass migration” approach to the switch, so patients were waiting for their nurse visits and possibly missing doses.

“We didn’t want this to be a barrier to a successful switch” to adalimumab, she said, and her trust understood that “forward planning was essential” for the adalimumab switch. “I wanted to make sure we got it right the first time.”

In order to prepare adequately, in June 2018, the trust began its planning process, even before the results of the tender for adalimumab had taken place. The home care team was also in agreement that early planning was crucial, and provided the trust with a list of current patients on Humira. The pharmacist confirmed which patients could be switched after patient consultation (pregnant patients, those with allergies to excipients, or those who expressed strong concerns about biosimilars were not eligible to be switched).

The final patient list was sent back to the home care team, and existing stock of Humira was allowed to taper off so that a biosimilar could be used from December 2018 onward.

Next, the pharmacist held weekly teleconferences with the home care companies to organize delivery of biosimilars and to assess what patients needed to be supported in the transition. Many patients, she said, did not eventually need nurse training because they had access to enough information to be comfortable with their administration.

As biosimilars began to roll out, each week, the home care companies sent a report that showed how many patients had a biosimilar dispensed, the number of failed deliveries, and any problems with the biosimilar. These reports continued until all 128 eligible patients had switched to biosimilar adalimumab.

Interestingly, no patients in the trust reported problems with citrates in their biosimilars. “AbbVie did a very good job of scaring our patients” about citrate ahead of biosimilar availability, she said, but no patients had to be moved to a citrate-free biosimilar option. Some patients told their nurses that their injection process “hurts a little bit, but I can live with it.”

Other biosimilars coming out soon may not have such a highly coordinated approach to switches, she said, so there may be different lead-ups to such switches in the future. Regardless of whether upcoming transitions will take a different approach, she urged pharma companies to take tight control of their supply chains and to ensure the smooth delivery of their stock to UK patients, especially as the nation approaches Brexit and concerns about supply are running high among stakeholders.

In a separate presentation, a UK value-based pricing advisor said that he expects upcoming UK biosimilar launches to take a very similar approach to the adalimumab transition; he pointed to the growing experience on how to switch patients as “a conductor for the orchestra of adopting biosimilars.”

He also noted that the United Kingdom has become particularly assertive with its incentives to switch patients. While gain sharing has been a feature of the UK system for some time, the Commissioning for Quality and Innovation body has now begun to make incentive payments to hospitals in order to reward performance in meeting NHS commissioning framework goals for biosimilars.