Rheumatologists Still Leery of Biosimilar Use, Study Says

Rheumatologists have reservations about prescribing biosimilars and want to see more payer support, savings benefits, and evidence of interchangeability, according to data presented in the inaugural issue of Rheumatology Insights, a research-based report published by Cardinal Health Specialty Solutions.

“The results of our study show that rheumatologists are remarkably similar to other providers in their views on biosimilars. That is, despite an overwhelming familiarity and comfort level, the majority are reluctant to use biosimilar products,” said Gordon Lam, MD, medical director of clinical and translational research at NorthEast Rheumatology for Atrium Health in Charlotte, North Carolina, in the report.

Of the rheumatologists included in the analysis, 45% said that they are comfortable with the FDA approval process for biosimilars but still have concerns regarding interchangeability and extrapolation for other indications without clinical trial evidence. Another 45% said they are comfortable with the FDA approval process for biosimilars.

Additionally, 10% of rheumatologists feel that the FDA is rushing biosimilars through the approval process without requiring enough safety and efficacy data.

With regard to familiarity with biosimilars, 53% of rheumatologists described themselves as very familiar with biosimilars, and 45% said they are somewhat familiar with them.

Cost Savings Disputes

Cost savings was cited as a moderately to extremely important issue for 90% of physicians when considering a biosimilar treatment. An additional 76% said that favorable economics of biosimilars for their practice was moderately to extremely important to them.

The report also noted that 92% of the rheumatologists surveyed agreed that the current economics of biosimilars are not favorable enough to motivate them to switch from reference products.

“These concerns are valid. Real-world evidence (RWE) of the cost-effectiveness of biosimilars in the United States is scant, and presently, most biosimilars are priced at only 15% to 40% below the reference product list price,” said Lam.

Biosimilar prices are expected to decrease as more products enter the market, just as they did in the generics market.

In a related presentation at the recent National Comprehensive Cancer Network 2020 Virtual Conference, Michael Kolodziej, MD, vice president and chief innovation officer for ADVI Health, concluded that the generics market has demonstrated that significant discounts can be achieved, but “it takes a while to get to that discount.”

Top Concerns for Rheumatologists

Rheumatologists said their top biosimilar prescribing concerns were efficacy (38%), evaluating when to prescribe a biosimilar versus a reference product (21%), lack of economic benefit (21%), and lack of payer adoption (13%).

Overall, 66% of physicians stated that they would be unlikely to switch patients from a reference product to a biosimilar until there is greater adoption among payers.

That may not happen until there is a threshold level of RWE for payers to digest, Lam said.

“Uncertainty and lack of payer adoption may limit utilization and hence impede accumulation of RWE, but RWE is often needed to alleviate uncertainty and increase payer adoption,” he said.

Similar research was presented last year at the American College of Rheumatology’s annual meeting. Investigators found that although US rheumatologists have growing awareness of biosimilars, they still are reluctant to switch stable patients to biosimilars or to extrapolate use of biosimilars to indications not on the label for those products.