The inevitable rise of biosimilars


In the latest in our series based on 2017 UTS Pharmacy Barometer results, John Montgomery looks at how pharmacists view the riding tide of biosimilar medicines 

There’s little doubt biosimilar medicines will have a profound impact on Australia’s pharmaceutical scene. Now available in more than 60 countries, biosimilars provide an alternative to biological medicines and can be used to treat a broad range of serious disorders, including rheumatoid arthritis, ulcerative colitis, diabetes and cancer.

Biosimilars bring many economic benefits, too. They have the potential to encourage competition in the market, leading to more affordable medicines. For pharmacies, lower-cost biosimilars have a positive impact on profitability and may give patients access to otherwise expensive treatments.

There is ample evidence, however, that pharmacists remain quite reluctant to dispense biosimilars or provide patients with information about them. This is despite biosimilars being used around the world for over a decade.

The most recent UTS Pharmacy Barometer found that just 37% of pharmacists are “comfortable” providing information to their patients about biosimilars. Only 29% were confident substituting biosimilars for medicines they were prescribing currently, while as little as a third said they were prepared to dispense them to new patients. Just 16% were aware of a biosimilar awareness program that was launched by the Department of Health in May 2015.

The results appear to indicate that there is a core group of pharmacists that are confident in recommending biosimilars to new and existing patients. Many more, however, remain neutral in their confidence and preparedness to deal with biosimilars,

I believe it’s a matter of time before pharmacists embrace biosimilars. These medicines are still in their infancy in community pharmacies, so it’s not surprising that pharmacists don’t have a high level of confidence dispensing them widely.

The introduction of ‘traditional’ generic medicines followed a similar pattern. In the early days, pharmacists were concerned about their safety and uncertain if their patients would accept generics as acceptable replacements for their usual medicines. But a joint effort by key stakeholders – the government and suppliers, as well as pharmacists and pharmacy leaders – helped overcome these barriers.

Generics are now a large part of the Australian pharmaceutical market. They have almost universal awareness and there is little residual concern about whether they are safe to use.

The one significant difference, though, is that biosimilars – being biologics – are not identical to the reference biological medicines so their clinical outcomes require more focus.

Cost savings, of course, will also help persuade pharmacists and patients that biosimilars are a worthwhile option. Over time, due to a combination of price disclosure and competition, generics have become less expensive for patients and taxpayers and the same cost benefits will flow for biosimilars. A recent report in Pharma in Focus identified that $220 million in ongoing savings would result when the new 25% price reduction on the first generic is applied to a wave of biologic brands for which biosimilar competition is expected soon.

Certainly, more needs to be done by government and suppliers to improve the confidence level of biosimilars for community pharmacists. The Department of Health Biosimilar Awareness Initiative appears to need a boost. But I’m optimistic that given more time and greater education, pharmacists and patients will come to see biosimilars as a mainstream alternative.

UTS Adjunct Professor John Montgomery is CEO of Montrose Pharma

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