Background There is currently limited evidence relating to, and thus understanding of, physician views on prescribing biosimilars in the real world.
Objectives Our aim is to address this lack of understanding, specifically by describing rheumatologists' motivations to prescribe, and perceptions of, biosimilars for Rheumatoid Arthritis (RA), Axial Spondyloarthritis (AxSpA) and Psoriatic Arthritis (PsA).
Methods The Adelphi Biosimilars Therapy Insight Programme uses a well-established methodology, similar to that used in over 100 separate projects, and contains real-world, cross-sectional survey data from 50 German rheumatologists who currently prescribe biosimilars, collected in Q4 2015 - Q1 2016 in RA, AxSpA and PsA. Rheumatologists report their use of current therapies, therapy preferences, as well as experiences with prescribing biosimilars, including their reasons for prescribing them.
Results Rheumatologists reported that in the absence of restrictions or guidelines for 1st and 2nd line biologics their preference would be to prescribe bio-originator; only 8%, 18% and 20% stated a biosimilar would be their preferred 3rd line option for Ra, AxSpA and PsA respectively. However, despite these data on rheumatologist preference it was shown that when biosimilars were prescribed, it was in place of a 1st and 2nd line biologic in 88% and 69% of cases respectively.
Key reasons for biosimilars prescribing were non-clinical with 77% of rheumatologists indicating cost related issues and 73% reported a desire to gain experience with biosimilars. Only 60% stated they prescribed biosimilars because they were convinced of equivalent efficacy with bio-originators. Respondents indicated that with increased discounts they would be more likely to prescribe biosimilars in stable patients. However, in patients where the bio-originator has failed, 18% of rheumatologists would be motivated to prescribe the biosimilar if it was 10% cheaper than bio-originator. Rheumatologists (86%) said that they would consider using a biosimilar once they had decided to prescribe that therapy, but the availability of a biosimilar was unlikely to affect the choice of therapy prescribed.
Conclusions The results clearly indicate that the main drivers for biosimilar use are cost and desire for experience. It is possible that the desire to gain experience in prescribing biosimilars is a consequence of physicians anticipating payer pressure to prescribe biosimilars in future, even in well controlled bio-originator patients. Physician preference is to prescribe bio-originators but cost savings are leading to their use, mainly in place of the bio-originator of the same therapy. We observed that the majority of rheumatologists are not convinced of the interchangeability of biosimilars as they preferred not to switch (and were unlikely to switch) well managed patients from bio-originators to biosimilars. Given the economic pressures towards prescribing biosimilars, it is critical that the impact of non-clinical switches be fully understood to ensure patients are not put at undue risk for economic reasons. Given that German physicians are responsible for drug prescribing budgets these data may help provide insights into modeling in other markets where clinicians have to work with other budget holders to decide on appropriate use of drugs.
Disclosure of Interest E. Sullivan Employee of: Adelphi Real World, J. Piercy Employee of: Adelphi Real World, J. Waller Employee of: Adelphi Real World, C. Black Shareholder of: Merck, Employee of: Merck, S. Kachroo Shareholder of: Merck, Employee of: Merck