Physicians’ attitudes to replacing innovative biologics with biosimilars varies significantly depending on their specialty, according to research by Decision Resources Group.
“Endocrinologists are the most resistant physician group to biosimilars,” said Kate Keeping, Senior Director of Biosimilars Research. “They’re treating patients chronically – and it’s written into their product labels that they must be careful before switching medicines. They’re concerned about whether changing a patient’s insulin will cause an immunogenic reaction.”
She added that because insulin users administer the drug themselves, they are more likely to take note if their prescription changes to a biosimilar.
“They’re patient-administered drugs taken every day – if patients are happy with current treatment it’s a lot harder to switch them. Whereas for an IV-delivered monoclonal antibody for oncology, [often] the patient doesn’t know what they’re receiving, and there’s less of a concern with immunogenicity.”
Big players’ success
Biosimilar makers deciding their next target should think beyond numbers and consider the impact of their brand, said Keeping. “It’s not always about sales and patent expiry. In a competitive environment, such as insulin, the big players such as Sanofi, Lilly and Novo Nordisk are dominant and you would need to make a significant volume to compete.”
The manufacturer of a biosimilar strongly influences doctors’ prescribing choices, with familiar names winning out, according to research.
“When we ask physicians how they’ll choose which biosimilar to prescribe, first they say they’ll look at clinical data for any minor differences in safety and efficacy. If they can’t differentiate based on that, they look at price.”
But when biosimilars show no difference in clinical data and price, doctors turn to the manufacturer’s name, she said. “What we’re seeing is they look at the company manufacturing and marketing the biosimilar. They’re complex drugs so they want them to be safe and effective.
“Companies like Amgen and Pfizer that are already familiar to physicians and payers – because they market drugs to doctors – they tend to be viewed as more trustworthy.”
Changing doctors’ habits
Prescribing habits surrounding biosimilars will remain the same “until payers take a stronger role,” said Keening.
“In some countries, for example Italy, there is a strong move to advocating the use of biosimilars in treatment-naïve patients. There, the physician is under pressure to use biosimilars.
“In other European markets we’re seeing more pressure from payers to use biosimilars. France is a high-profile example at the moment – they’re debating a change which will allow pharmacists to dispense biosimilars to treatment-naïve patients. But the doctor can override that by marking the prescription [for the reference product only].”
Click here to zoom in the graph of doctors' perception of biosimilars: