There have been many articles written about the potential for biosimilars to lower drug prices, benefitting nearly every party in the healthcare supply chain. That promise though, is not without hurdles. But one health plan may have found a way forward.
Kayla Hubrich, PharmD, clinical pharmacy specialist in gastroenterology and rheumatology and Lynsey Smith, PharmD, BCACP, clinical pharmacy specialist in rheumatology and dermatology, both at Kaiser Foundation Health Plan of the Northwest (KPNW), spoke at the recent AMCP Nexus about their plan’s efforts to increase biosimilar adoption.
They said that increased biosimilar use could lead to a $54 billion reduction in biologic spending from 2017 to 2026—resulting in lower premiums and out of pocket costs for patients, and a larger range of available therapeutic interventions previously restricted due to budget constraints for payers.
Interchangeable vs. biosimilar
One major hurdle for biosimilar adoption is due to FDA classifications, which require extra provider intervention.
Biosimilars, as defined by the FDA, are products that are highly similar and have no clinical difference to reference products. Because biosimilars are not exact copies of their reference products, changing from a reference product to a biosimilar requires provider approval.
Interchangeable products, on the other hand, are identical to a reference product and can be substituted for the reference product without prescriber involvement. However, there are currently no biologic products that meet this classification—and therefore all current biologic products require prescriber involvement to change.
As Hubrich and Smith demonstrated, many physicians are hesitant to make the change to biosimilars.
One part of the problem is that only five biosimilars have launched. Many more are FDA-approved, but most are caught up in some sort of patent litigation. As a result, many prescribers have had little exposure to any kind of biosimilars.
In a 2015- 2016 survey by the Biosimilars Forum, physicians were asked to share their opinion on the statement “Biosimilars will be safe and appropriate for use in naïve and existing patients.” Fewer than half of physicians (44.8%) agreed. When asked about the safety of biosimilars, 35.9% felt that they were unsafe because they were approved through an abbreviated pathway. Physician’s main concerns with biosimilars were cost savings, interchangeability/substitutability, and safety and efficacy.
Overall, Smith said, physicians are unlikely to make the switch to biosimilars unless required to do so.
Another major hurdle is convincing patients that biosimilars are effective. Smith pointed to one study showing that while 70% of patients believe that generic medications are a better value, only 37% would prefer a generic to a brand medication.
According to Smith, patients are also wary of switching medications for nonmedical reasons. This wariness can cause additional problems. Smith and Hubrich both discussed the problem of potential so-called “no-cebo” effects when switching to biosimilars. Like the placebo effect, the no-cebo effect occurs when patients are convinced a drug won’t work and consequently have negative reactions to those medications. Therefore, for any changes to biosimilar regimens to be successful, patients would need to be educated. Smith stressed that the more educated patients are about biosimilars, the more positive their outlook will be.