Dr Marcus Snow: Automatic Substitution of Biosimilars in Rheumatology

Marcus H. Snow, MD, Assistant Professor Rheumatology, University of Nebraska, discusses concerns about automatic substitution of biosimilars for reference products.


Do you have concerns about automatic substitution of biosimilars for reference products?

Yes, I do and I guess I don’t, to some degree. I do have [concerns with] automatic substitution, but it depends on who is doing the substitution and what is being substituted. If I place someone on a new medication and instead of getting the bio-originator product, I get a biosimilar as my first medication, right now I have no qualms about that. The patient is starting on a new medication, it is what it is, and we will see how they respond. However, if they are already on a bio-originator product and they are switched over, I have some concerns about switching a patient who is doing well. The third avenue where you could see switching, which I would be very opposed to, would be someone who is on medication—we’ll say etanercept—and the insurance company or the payer decides that adalimumab biosimilar is the medication of choice. Switching a patient from one drug, not only to a biosimilar, but to a biosimilar of another medication, has huge implications and is very concerning for me. As a rheumatologist, the problem with rheumatoid arthritis is that early on, we have joint damage, and if you lose control of the disease activity, in the long run you can see worse outcomes with increasing rates of disability, etc.

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