Who Will Influence Biosimilar Uptake: Physician, Pharmacist, Patient, or Payer?

Carole Ellis
April 27, 2017
In 2006, the European Union approved its first biosimilar drug. Now, more than a decade later, the United States and its FDA continues to struggle with how to incorporate these unique pharmaceutical treatments into mainstream medical practice. The complex and organic nature of these biological drugs makes it difficult to test and approve them in a traditional setting—biosimilar treatments will need to gain some degree of acceptance in at least 1 of 4 distinct medical and scientific communities before they can enter the mainstream. Physicians, pharmacists, patients, and health plans will play key roles in the eventual uptake of biosimilars by the broader marketplace, and each population must be reached in a very targeted way.

Perhaps the biggest obstacle to biosimilar uptake is the broad lack of familiarity with these medicines in most disciplines. For example, despite the fact that biologic and biosimilar drugs have played a vital role in cancer treatment over the past decade in Europe, a 2011 survey of oncologists in found that about 1 in 4 doctors had never heard of biosimilar drugs and more than half admitted that they had “no or slight familiarity” with these treatments.

“People are not going to purchase or prescribe something they do not understand,” said Joseph P. Fuhr, Jr, PhD, professor emeritus at Widener University and member of The Center for Biosimilars editorial board.

“We have a lot of work to do on education,” added Molly Leber, PharmD, BCPS, FASHP, a manager of medication policy and formulary management in the Yale New Haven Health System who also serves on the editorial board at the Center for Biosimilars. “There are numerous surveys that have shown healthcare professionals and patients don’t know about the current drug approval process [for biologics] and even less about biosimilars.” Leber added that many healthcare professionals still have concerns about the safety of biosimilars because of the general lack of awareness about the approval process, and that patients often do not realize that there are alternatives to their current biologic therapies.

While the expanding presence of oncological biosimilars and biologics in the US marketplace will bring these drugs more to the forefront of the prescribing physician’s mind both in oncology and elsewhere, there are certainly some roadblocks to overcome before they become anything other than a last resort. Many physicians who are familiar with biosimilar and biologic drugs still tend toward prescribing more familiar treatment options because biosimilars feel risky; a biosimilar’s corresponding biologic often bears the full weight of testing and trials with the result that the “confirmatory trials” for biosimilar safety required by the FDA may feel inadequate. It is, in fact, the case that for biosimilars the weight of proof of safety and efficacy lies largely within the proof of similarity to a biologic. Further complicating the prescription process, because biosimilars are organic and their effects may evolve in a patient who takes them over time, physicians may be reluctant to prescribe a treatment that feels unpredictable to both the patient and themselves.


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