Skip to main content

Physician Understanding and Willingness to Prescribe Biosimilars: Findings from a US National Survey

BioDrugs volume 35, pages 363–372 (2021)Cite this article

Abstract

Background

Biosimilars have the potential to increase patient access and significantly reduce healthcare costs in the US. However, uptake in the US has been slower than anticipated, limiting the benefits of biosimilar competition. Understanding the factors that affect uptake is critically important to realize the benefits of biosimilars.

Methods

A US national survey study was conducted electronically from December 11, 2019 to January 8, 2020. The survey was administered to 507 US healthcare professionals practicing in dermatology, gastroenterology, hematology, oncology, nephrology, or rheumatology. The survey evaluated prescriber attitudes toward biosimilars in general, as well as prescriber decision making, using a series of hypothetical scenarios with fictional biological products.

Results

Fewer than half had a baseline understanding of key elements of biosimilarity, even among respondents who had previously prescribed a biosimilar. Regardless of previous experience, all respondents benefited from receiving additional information about biosimilarity, indicating the potential benefits of educational efforts for prescribers across all specialties and levels of experience. Prescriber choice was driven primarily by formulary status; however, respondents identified a variety of factors that would influence their willingness to prescribe a biosimilar, including financial savings to the patient, pharmacovigilance, patient experience, and education on the FDA approval process. Over one-third of participants indicated a preference for reference products and nearly half indicated a hesitancy to try biosimilars until they have been on the market longer. Naming conventions for biosimilars did not affect prescribers’ willingness to prescribe biosimilars.

Conclusions

Gaps in prescriber knowledge and hesitancy toward biosimilars remain significant challenges for biosimilar uptake. While formulary status of a biosimilar product strongly influences prescriber choice, additional prescriber education on biosimilarity is needed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 49.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Mulcahy AW, Hlavka JP, Case SR. Biosimilar cost savings in the United States: initial experience and future potential. Rand Health Q. 2018;7(4):3.

    PubMed  PubMed Central  Google Scholar 

  2. Zhai MZ, Sarpatwari A, Kesselheim AS. Why are biosimilars not living up to their promise in the US? AMA J Ethics. 2019;21(8):E668–78.

    Article  Google Scholar 

  3. Cost Estimate. S. 1695: Biologics Price Competition and Innovation Act of 2007. Washington, DC: Congressional Budget Office. 2008.

  4. Food and Drug Administration. FDA-Approved Biosimilar Products. https://www.fda.gov/drugs/biosimilars/biosimilar-product-information. Accessed 31 Jan 2021.

  5. Herndon K, Braithwaite J, Berry B, Bourget K. Biosimilar perceptions among healthcare professionals and commercial medical benefit policy analysis in the United States. BioDrugs. 2021. https://doi.org/10.1007/s40259-020-00463-6.

    Article  PubMed  Google Scholar 

  6. IQVIA Institute for Human Data Science. Biosimilars in the United States 2020–2024. https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/iqvia-institute-biosimilars-in-the-united-states.pdf?_=1602260351753. Accessed 9 Oct 2020.

  7. Sarnola K, Merikoski M, Jyrkka J, Hameen-Anttila K. Physicians’ perceptions of the uptake of biosimilars: a systematic review. BMJ Open. 2020;10(5):e034183. https://doi.org/10.1136/bmjopen-2019-034183.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Leonard E, Wascovich M, Oskouei S, Gurz P, Carpenter D. Factors affecting health care provider knowledge and acceptance of biosimilar medicines: a systematic review. J Manag Care Spec Pharm. 2019;25(1):102–12.

    PubMed  Google Scholar 

  9. Barsell A, Rengifo-Pardo M, Ehrlich A. A survey assessment of US Dermatologists’ perception of biosimilars. J Drugs Dermatol. 2017;16(6):612–5.

    PubMed  Google Scholar 

  10. Cohen H, Beydoun D, Chien D, Lessor T, McCabe D, Muenzberg M, et al. Awareness, knowledge, and perceptions of biosimilars among specialty physicians. Adv Ther. 2016;33(12):2160–72. https://doi.org/10.1007/s12325-016-0431-5.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cook JW, McGrath MK, Dixon MD, Switchenko JM, Harvey RD, Pentz RD. Academic oncology clinicians’ understanding of biosimilars and information needed before prescribing. Ther Adv Med Oncol. 2019;11:1758835918818335. https://doi.org/10.1177/1758835918818335.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Cohen HP, McCabe D. The importance of countering biosimilar disparagement and misinformation. BioDrugs. 2020;34(4):407–14. https://doi.org/10.1007/s40259-020-00433-y.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chambers JD, Lai RC, Margaretos NM, Panzer AD, Cohen JT, Neumann PJ. Coverage for biosimilars vs reference products among US Commercial Health Plans. JAMA. 2020;323(19):1972–3.

    Article  Google Scholar 

  14. Yazdany J, Dudley RA, Lin GA, Chen R, Tseng C-W. Out-of-pocket costs for infliximab and its biosimilar for rheumatoid arthritis under Medicare Part D. JAMA. 2018;320(9):931–3.

    Article  Google Scholar 

  15. Karaca-Mandic P, Chang J, Go R, Schondelmeyer S, Weisdorf D, Jeffery MM. Biosimilar filgrastim uptake and costs among commercially insured, Medicare Advantage. Health Aff (Millwood). 2019;38(11):1887–92. https://doi.org/10.1377/hlthaff.2019.00253.

    Article  Google Scholar 

  16. Kozlowski S, Birger N, Brereton S, McKean SJ, Wernecke M, Christl LA, et al. Uptake of the biologic filgrastim and its biosimilar product among the medicare population. JAMA. 2018;320(9):929–31.

    Article  Google Scholar 

  17. Chen AJ, Ribero R, Van Nuys K. Provider differences in biosimilar uptake in the filgrastim market. Am J Manag Care. 2020;26(5):208–13. https://doi.org/10.37765/ajmc.2020.42786.

    Article  PubMed  Google Scholar 

  18. Baker JF, Leonard CE, Lo Re V, Weisman MH, George MD, Kay J. Biosimilar uptake in academic and veterans health administration settings: influence of institutional incentives. Arthritis Rheumatol. 2020. https://doi.org/10.1002/art.41277.

    Article  PubMed  Google Scholar 

  19. Nonproprietary Naming of Biological Products: Guidance for Industry. FDA-2013-D-1543. Silver Spring: Food and Drug Administration. 2017.

  20. Nonproprietary Naming of Biological Products: Update Guidance for Industry (Draft Guidance). FDA-2013-D-1543. Silver Spring: Food and Drug Administration. 2019.

  21. Sarpatwari A, Barenie R, Curfman G, Darrow JJ, Kesselheim AS. The US biosimilar market: stunted growth and possible reforms. Clin Pharmacol Ther. 2019;105(1):92–100. https://doi.org/10.1002/cpt.1285.

    Article  PubMed  Google Scholar 

  22. Chang LC. The biosimilar pathway in the USA: An analysis of the innovator company and biosimilar company perspectives and beyond. J Food Drug Anal. 2019;27(3):671–8. https://doi.org/10.1016/j.jfda.2019.03.003.

    Article  PubMed  Google Scholar 

  23. Jordan JB, Christl L. FDA Biosimilar Action Plan: could improving pharmacovigilance of biologics improve patient and physician confidence in biosimilars? Expert Opin Drug Saf. 2020;19(3):229–32. https://doi.org/10.1080/14740338.2020.1733966.

    Article  PubMed  Google Scholar 

  24. O’Callaghan J, Bermingham M, Leonard M, Hallinan F, Morris JM, Moore U, et al. Assessing awareness and attitudes of healthcare professionals on the use of biosimilar medicines: a survey of physicians and pharmacists in Ireland. Regul Toxicol Pharmacol. 2017;88:252–61. https://doi.org/10.1016/j.yrtph.2017.06.013.

    Article  PubMed  Google Scholar 

  25. Chapman SR, Fitzpatrick RW, Aladul MI. Knowledge, attitude and practice of healthcare professionals towards infliximab and insulin glargine biosimilars: result of a UK web-based survey. BMJ Open. 2017;7(6):e016730. https://doi.org/10.1136/bmjopen-2017-016730.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Baji P, Gulacsi L, Golovics PA, Lovasz BD, Pentek M, Brodszky V, et al. Perceived risks contra benefits of using biosimilar drugs in ulcerative colitis: discrete choice experiment among gastroenterologists. Value Health Reg Issues. 2016;10:85–90. https://doi.org/10.1016/j.vhri.2016.07.004.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Elisabeth Newcomb Sinha and Zahava Hurwitz for assistance with the survey.

Author information

Authors and Affiliations

  1. US Department of Health and Human Services, Washington, DC, USA

    Allison R. Kolbe, Aaron Kearsley & Amber Jessup

  2. US Food and Drug Administration, Silver Spring, MD, USA

    Lubna Merchant, Eva Temkin, Archita Patel & Jing Xu

Authors
  1. Allison R. Kolbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aaron Kearsley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lubna Merchant
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eva Temkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Archita Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jing Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Amber Jessup
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allison R. Kolbe.

Ethics declarations

Funding

The funding for this study was provided by the US Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (Contract No. GS-10F-0067X Task Order No. HHSP233201400379G). This project was supported in part by an appointment (ARK) to the Research Participation Program at the Department of Health and Human Services administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and the Department of Health and Human Services.

Conflict of interest

The authors declare no conflicts of interest.

Availability of data and material

Data are available upon request.

Ethics approval

This survey study was reviewed by the New England Independent Review Board and was deemed exempt.

Author contributions

AJ conceived of and designed the study. ARK, AK, and JX analyzed survey results. All of the authors assisted with data interpretation. ARK prepared the manuscript with contributions from all the authors.

Additional information

Disclaimer

Any opinions presented in this paper are of the authors only and do not represent the views of their employers. Dr Jessup’s contribution occurred entirely when she worked at the Assistant Secretary for Planning and Evaluation, Washington D.C., USA. She is currently affiliated with the HHS Office of the Inspector General.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 495 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kolbe, A.R., Kearsley, A., Merchant, L. et al. Physician Understanding and Willingness to Prescribe Biosimilars: Findings from a US National Survey. BioDrugs 35, 363–372 (2021). https://doi.org/10.1007/s40259-021-00479-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40259-021-00479-6