Have Physician Attitudes Changed Toward Biosimilars In The Last Year?
By Diane Hayes, Ph.D., president and co-founder, InCrowd
With four biosimilar drugs now approved for sale in the U.S. in 2016 and at least 3 more likely to achieve approval in 2017, one would think U.S. physicians are increasingly on board with biosimilars as an advance for their patients. After all, biosimilars are expected to increase treatment options and promise to lower costs on expensive medicines.
Yet a recent publication of biologics-prescribing physician perceptions from late 2015 to early 2016 and an analysis of their implication for physician outreach today, identified a few perplexing findings. For instance, there was a heightened skepticism among the physicians who were the most aware of biosimilars.
In September 2016, life science market insights technology firm InCrowd launched a new tracking report on the perceptions of potential biosimilar prescribers. This effort was a follow-up to a survey taken in February 2016. This report provides a more current update on physician awareness about biosimilars, their anticipated prescribing habits, how physician thought processes are evolving around pharmacy-level substitution, and the information sources they rate as highly important as they make these decisions on behalf of patients.
Steady Awareness Overall, Especially Among Gastroenterologists
The tracking study compared responses of unique groups of physicians across five subspecialties in which biologics prescribing is significant: dermatology, endocrinology, gastroenterology, oncology, and rheumatology.
Health care professionals (HCPs) responding had roughly the same familiarity with biosimilars in September than in February, with 63 percent knowing “almost everything possible” or “a good deal” about biosimilars, compared to 61 percent in February. Awareness increased especially among gastroenterologists, with more reporting they knew “a good deal” (+13 percent) or “a fair amount” (+11 percent) in September. This is not surprising, since three of the four biosimilars approved by the FDA treat autoimmune disorders that may impact these doctors’ prescribing options.
More Doctors Anticipate Prescribing Biosimilars
Eighty-four percent of responding physicians surveyed in September 2016 said they expect to prescribe, assume they will prescribe, or look forward to prescribing more biosimilars in the next 3 years. This is nice increase from the 70 percent responding in February 2016.
The research also reflects a decrease in physicians who would only prescribe biosimilars if they were forced to do so, or if there were specific patient conditions that warranted a switch from the biologic. This percentage dropped from 26 percent in February to 16 percent in September.
What’s The Hold-Up For Physicians?
When it comes to pharmacy-level substitution, doctors are saying “Not so fast.”
After the August 2016 report finding comparable safety and efficacy for the biosimilar TNF-alpha inhibitors used in rheumatoid arthritis and inflammatory bowel disease, one would expect that pharmacy-level substitutions would be met with less resistance in September’s survey. However, it seems more doctors now are expressing hesitation over pharmacy-level substitution than they were in February. While 28 percent said they would not prohibit biosimilar substitution in the February survey, September’s survey revealed only 17 percent claimed they wouldn’t stand in the way of substitution.
Looking more deeply at the results, more HCPs — 49 percent in September, up from 41 percent in February — were planning to prohibit substitutions in some cases, especially if an originator is working for a patient already.
Why the caution? Verbatim comments centered on two themes:
- Proof of complete compatibility: This reiterates the paper published in Advances in Therapy, which revealed only half of respondents understood that biosimilars must be as safe and effective as reference biologics. (Dermatologists and rheumatologists’ percentage levels were even lower.) “I would wait and let other doctors experiment on their patients,” said one oncologist in response to this InCrowd survey.
- Lack of physician control: “I'm the one treating the patient and addressing complications. NOT the pharmacist,” said a gastroenterologist who would prohibit all pharmacy-level substitutions.
Thought Leaders, Professional Society Opinions Matter More
Physicians are placing greater emphasis on thought leader opinions and professional organization guidelines — now at 55 percent from 46 percent in February — when they rank the top 10 most important factors in deciding to prescribe a biosimilar.
The most important considerations/drivers of biosimilar usage remain the same: efficacy (88 percent), safety (82 percent), out-of-pocket costs to patients (74 percent), ease of access for prescribing (64 percent), and interchangeability with the originator (67 percent) — with percentage levels holding consistent from February to September between the 5 specialties surveyed.
Discounts Still Drive The Choice
The majority of physicians are still looking for discounted pricing if they're going to prescribe biosimilars. For instance, 59 percent would prescribe a biosimilar over the originator at a 15 percent discount and 77 percent at a 25 percent discount. These figures remained roughly the same in the past six months. That said, however, given the choice, 35 percent of HCPs (compared with 36 percent in September) plan to prescribe the originator biologics first and foremost.
Study Methodology
With nearly half of HCPs believing that the increasing availability of biosimilars will result in more cost-effective healthcare, physicians sentiments on biosimilars are changing as market developments unfold. Taking their pulse periodically can provide invaluable insight into how healthcare providers respond and take advantage of biosimilars’ new treatment potential.
Wave two of InCrowd’s Biosimilars Research was captured data with InCrowd’s MicroTracker — a real-time market tracking solution that automates the design and fielding of data. The survey included responses from 150 U.S.-based, triple-verified, board-certified physicians in specialties where biologics prescribing is significant. Each of the five specialties — dermatology, endocrinology, gastroenterology, oncology, and rheumatology — were represented by 30 physicians who have been in practice between three and 39 years. Respondents have personally treated patients with biologics therapies, and were at least somewhat familiar with biosimilars. Physicians responded to a six-minute microsurvey between September 21 and 22, 2016.