Surveys on Biosimilar Awareness and Acceptance Reported at AMCP Nexus 2021

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Education is needed for both patients and pharmacists to ensure appropriate understanding, investigators reported at the Academy of Managed Care Pharmacy (AMCP) Nexus 2021 meeting.

It is thought that biosimilars for the treatment of rheumatoid arthritis (RA), psoriasis (PS), and inflammatory bowel disease (IBD), among other immune-mediated conditions, could help to save money and extend access for patients, but much depends on patient acceptance of this alternate type of biologic medicine.

At the Academy of Managed Care Pharmacy Nexus 2021 meeting, investigators presented findings from a survey of patients from the South, Midwest, and Puerto Rico that described patient attitudes toward anti–tumor necrosis factor (TNF) biosimilars.

They also presented findings from a survey of pharmacists and their knowledge of interchangeable biosimilars, which are biosimilars whose consistency and similarity to reference drugs has been tested in a rigorous switching study.

What investigators reported was that patients could be more accepting of biosimilars if they were targeted with education efforts; and pharmacists, while strong on state laws respecting interchangeable biosimilars, may lack the detailed understanding needed to appropriately understand FDA biosimilar approvals.

Patient Survey on Acceptance

The patient survey was conducted from December 2020 to January 2021 and included patients receiving a biologic therapy (44%; n = 221) or not (56%; n = 279). The latter group included 16% with past biologic use and 40% who had never used a biologic.

Patients with RA, PS, IBD, and psoriatic arthritis were included. None of them were currently receiving an infliximab biosimilar.

Authors of the study concluded that patients were largely receptive to the concept of biosimilar treatment and accepted that cost of treatment was a part of the health care decision process; however, most patients surveyed said they had not heard of biosimilars before.

Concerns about biosimilars that patients expressed were that adverse events peculiar to biosimilars might develop and efficacy might not equal that of reference agents.


Investigators said the following were also findings from the study:

  • Patients already receiving treatment with a biologic said they would switch to a biosimilar (43%) if recommended by their provider.
  • Patients would oppose a switch (49%) if their doctor recommended staying with the reference product but the insurance company required a switch.
  • Overall, just 24% of patients had heard of biosimilars.

Pharmacists and interchangeability

The survey of pharmacists on interchangeability was based on 500 survey responses.

Biosimilar interchangeability would enable pharmacists to make automatic biosimilar substitutions rather than consulting first with physicians, but pharmacists have limited understanding of this concept, according to findings from the pharmacist survey at AMCP.

Authors said just 20% of pharmacists knew that interchangeable status means pharmacists can make substitutions without consulting the physician who prescribed the medicine.

The survey said 53% knew that interchangeability of a biosimilar hinges on state laws. For example, a pharmacist can dispense a biosimilar in place of a reference product without physician approval only if it is consistent with state law. All states have adopted interchangeable legislation, but these laws are different state by state.

Community pharmacists were less likely to understand this difference than pharmacists in other practice settings (50% vs 54%-61%).

“Additional and focused educational strategies for US pharmacists are required to bridge these gaps and increase confidence in dispensing biosimilars,” authors of the study wrote.

The survey was conducted in March 2021, which is prior to when the first interchangeable biosimilar (Semglee, insulin glargine) was approved, in July 2021.

Authors said 83% answered correctly that interchangeable biosimilars are different from generic drugs, and 81% correctly answered that biosimilars approved for all indications of a reference product are not automatically interchangeable with that product.