The Limitations of Direct-to-Consumer Advertising for Biosimilars

Pharmaceuticals companies love direct-to-consumer (DTC) advertising; most television viewers hate it. Advertisements for biologics and small-molecule drugs to treat inflammatory bowel disease, rheumatoid arthritis, cancer, diabetes, HIV, and a host of other disorders come in clusters, targeting news hour and primetime viewers alike. I have nothing against the golfer Phil Mickelson, and I assume he has received real benefit from his anti-TNF therapy. However, my patience was worn thin a long time ago. Yet, the old adage must be true: Pharma wouldn’t run DTC ads if they didn’t work. Because they work is probably one reason why the US and New Zealand are the only countries that allow their use. And within the US, its use is ubiquitous: on television, radio, print newspapers and magazines, digital services, you name it.

As effective as they are, one wonders why DTC advertising has not been utilized by biosimilar companies to state their own case to the American public. Social media plays host to a tremendous amount of positive information on biosimilars, produced by biosimilar makers like Amgen, Coherus, Samsung Bioepis, Pfizer, among others. To reach the wider public, DTC ads may give American viewers more accurate information about biosimilars in general and their medications in particular.

Payers dislike traditional DTC advertising, because they are geared towards increasing prescriptions of the product in question. The pharma industry will argue that DTC ads are used for patient education and to encourage appropriate use of their product. In general, payers don’t believe it, and who can blame them? There have not been any independent studies that have shown that DTC improves patient care—only more product sold.

If DTC advertising is so effective, why don’t biosimilar manufacturers take to the satellite, cable, and airwaves? Perhaps the reason is that their consumer message will be difficult to determine. Unless the 60-second ad addresses something specifically said by a reference drug maker, the biosimilar company would have to work within the following frames of reference:

”Our biosimilar is just as safe and effective as …”
First, you don’t want to violate the cardinal rule of advertising and mention your competitor by name. Second, the consumer is expecting to hear “safer and more effective,” which biosimilars, of course, don’t claim to be.

”Our biosimilar can help alleviate your symptoms and improve your quality of life”
In other words, if a biosimilar manufacturer took the same DTC approach as other drug makers do today, they would not mention the competition. They would focus their message on their drug’s ability to effectively treat a disease, like any other brand. One problem with this approach is that it loses the opportunity to advance the agent as a potentially lower-cost biosimilar. There is another issue as well: Like any branded ad, it would need to state all the disclosures associated with the agent. That could raise a question in the mind of the viewer: “Are these new possible side effects, only associated with the biosimilar, and not experienced with the reference brand?” This approach may serve the biosimilar manufacturer’s revenue motive, but it fails to improve the perception of biosimilars in general. .

”Our biosimilar costs less than the reference drug”
Although this may be the case from the health system or payer perspective, this is not always the case from the consumer’s standpoint. Unless each health plan maintains a policy that cost sharing under the medical benefit is lower with biosimilars, this would not be true. Which it isn’t at the present time.

Elizabeth Sampsel, PharmD, MBA, Clinical Program Manager at MedImpact Healthcare Systems, pointed out to me recently that we can only make the argument that costs to consumers will decrease through lower premiums only if a critical mass of biosimilars are adopted by payers. That will entail that the payer perceives a lower net cost for the biosimilar relative to the reference product.

The reasonable expectation is that consumers will pay the most attention if biosimilars directly cost them less than the reference biologic. In some cases, patient biosimilar use may be incentivized by lower cost sharing, but without widespread use of a biosimilar-only tier or co-insurance, we cannot say broadly that biosimilars cost patients less.

*We need biosimilars, because…”
This is a different message, and opportunity. The message is not necessarily aimed at current patients. It is targeted to everyone watching. We need biosimilars, because their lower costs to the US health care system allows more people to access these valuable but expensive medications.

We need biosimilars, because they create competition where none existed before.

We need biosimilars, because they are extremely similar to the biologics people see in other DTC advertising and are expected to provide effectiveness and safety that is not clinically different than these medications, and lower overall health costs.

The problem with this messaging is that it will also require an explanation to the lay public of what a biosimilar is and is not. That’s a lot for the average person to digest (and not in 60 seconds). That means a biosimilar DTC campaign with multiple messages to gain widespread awareness. A 30-second advertisement during the Super Bowl costs only $5 million. Well, we have to start somewhere…

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