Sometime ago, the European Crohn’s and Colitis Organization (ECCO) found that sequential surveys had demonstrated improving physician comfort with prescribing biosimilar infliximab. This resulted in ECCO’s change in its position on switching infliximab. As one can imagine, this occurs only with experience, and often that experience is gained first by using the drugs in new patients only.
According to Ha Kung Wong, Partner, Venable LLP, physician comfort and education is still the primary determinant of biosimilar uptake, even in Europe. In his remarks at the recent ACI Biosimilar Summit in New York City, Mr. Wong emphasized that although price will enable a biosimilar to gain a foothold, it is not the only or most important factor. This is somewhat surprising; the competitive tendering system in many countries have resulted in significant price variation, including steep discounts in some locations.
Mr. Wong explained that in Norway and Denmark, Remsima uptake has risen through deep discounts, though in other countries, discounts were far less extreme. On the other hand, less variation has been seen with trastuzumab pricing. Mr. Wong said, “Regardless, the uptake of biosimilars has been quite high across the EU. For example, Samsung’s Imraldi reached 60% uptake in Germany after only a very short time.”
He pointed out that “price does increase marketshare. But growth in uptake is still driven by biosimilar use in new patients.” Ha Kung Wong said that even in the EU, resistance to switching patients from a reference product to a biosimilar continues.
“The number 1 factor is MD resistance to switching,” he stated, although patient resistance is also apparent. Considering the heavy involvement of EU countries in educating doctors and patients with regard to biosimilars, more needs to be done if systematic switching of patients to biosimilars will contribute more fully to the industry’s success.
This experience in Europe is extremely pertinent to the situation in the US. Physicians are beset by costly administrative efforts to meet payers’ prior authorization and step edit requirements, and they may be also less experienced in the prescribing of biosimilars than their European colleagues. If the relative value of the biosimilar is not substantial enough, expect that prescriber uptake will grow only slowly. Consider not necessarily the case of infliximab, but the newest categories to likely hit the market—the biosimilars for the treatment of cancer (e.g., trastuzumab and bevacizumab). These prescribers will need some time to become comfortable with treating their vulnerable patients with biosimilars, and the requirement for use in “new” patients may not apply. It would be feasible to switch cancer treatment after completion of any cycle, as well as for recurrent tumors.