Accumulating evidence points to physicians’ growing comfort with prescribing biosimilars. A newly published study from the Journal of Managed Care and Specialty Pharmacy, based on a 2023 survey, found that physicians treating immunologic disorders were “likely” or “very likely” to prescribe a biosimilar for a new start patient as well as to recommend biosimilars for patients being switched from reference drug therapy. This finding aligns nicely with those of a 2024 healthcare provider survey, revealing that these specialists are increasingly comfortable prescribing biosimilar medications.
In the study by Cardinal Health and Pfizer, 249 physicians from diverse practice settings (dermatologist, rheumatologist, gastroenterologists) Were queried about biosimilars prescribing as well as barriers to the use of biosimilars. The study also surveyed pharmacists, but since they are not prescribers we will not focus on their particular attitudes towards new starts and switches. The surveys took place between August and October of 2023, after the introduction of the main adalimumab biosimilar competitors in the US. Mean age of the physicians was 51 years with an average of 18 years in practice.
The survey was primarily focused on providers’ understanding of interchangeability and state pharmacy laws, but I found the more compelling story to be in its discussion of physician attitudes toward biosimilars.
The researchers found that approximately 76% of the physicians were likely (45%) or extremely likely (21%) to recommend a biosimilar product for patients receiving the biologic for the first time. For patients being switched from the reference product, more than half of the physicians surveyed were likely (39%) or extremely likely (17%) to recommend the biosimilar product.
In the latter case, as a practical consideration, clinicians may not have much leeway in deciding whether to maintain their patient on the reference product: this may be the result of a policy change or formulary change by the health plan providing coverage. Routinely, physicians point to formulary decisions and coverage policies as the greatest factor in prescribing immunology drugs with biosimilar competition. This does not imply that a physician will not seek a medical exception for a patient who is currently receiving a reference drug like Humira, but it does suggest that their willingness to dive into the administrative procedure necessary to keep their patient on Humira may be waning.
These results are largely in line with those of research conducted for the 2025 Teva biosimilar Trend Report. (Disclosure: I was the writer of the Teva report). In that survey, conducted in the summer of 2024, 73 rheumatologists, dermatologists and gastroenterologists participated. Nearly half of those physicians indicated they were not at all concerned about patient acceptance of biosimilars, a vast improvement from the prior year survey (< 10%). This may be the result of their accumulated experience with adalimumab biosimilars through mid 2024. On average, they rated their own resistance to switch to a biosimilar as a 3.4 on a 7-point scale (7 = substantial resistance). About one-third of physicians responding have minimal to no concerns about biosimilar safety or side effects relative to the reference product, with average ratings of 2.6 and 2.8, respectively, on a 7-point scale (7 = substantial concern). Eighty-five percent agreed that biosimilars contribute to improved patient care. However, they are unconvinced that biosimilars lower patients’ out-of-pocket costs for these immunology products: 88% said that absence of patient savings (considering patient co-pay support) was the main barrier to biosimilar adoption.
Overall, physician concerns regarding biosimilars in categories where there is ample biosimilar experience (as opposed to, for instance, neurology) continues to dwindle. This is likely a combination of factors, not the least of which being the evidence for biosimilar safety and efficacy, but also insurance company and formulary pressure.
