Biosimilars in Rheumatology: Past, Present, and Future

Roy Fleischmann, MD, answers our questions about the present state of biosimilars in the United States, why they are not used as widely in the US versus other parts of the world, and the impact of patient-reported experiences of biosimilars. We also delve into ways in which to make biosimilars more accepted by patients and how rheumatologists can help to achieve this goal.

Editor’s Note: Check back throughout the week as additional segments are posted.

Roy Fleischmann, MD: History and Implementation of Biosimilars in Rheumatology

Roy Fleischmann, MD: The Current State of Biosimilars

Roy Fleischmann, MD: The Future of Biosimilars

Highlights include:

Rheumatology Network: What are your thoughts on implementing biosimilars?

Roy Fleischmann, MD: Let me start out by saying that I think that biosimilars are, in most patients, very similar to the biooriginal. Most patients who will respond to the biooriginal will respond to the biosimilar. The question, though, is in terms of access. In the United States, it's been very difficult to get access to the biosimilars in terms of the willingness of pharmacy benefit managers to utilize biosimilars. The problem in the United States is the rebate system. A developer of the biooriginal can pay a rebate to the pharmacy benefit manager. And that is quite profitable to a pharmacy benefit manager. What we're seeing now is that most pharmacy benefit managers will ask for use of the biooriginal because of that rebate. And there are entities that do use the biooriginal. But what's problematic is that although they're cheaper, in many cases it’s not cheaper to the patient. The patient still has the same copay, and they have the same problems they have with the biooriginal. They may be cheaper to the entity that's using the biosimilar, but it’s not passing on to the patient. This is different than many countries in the world in which there is a single payer, usually the government, and the government does buy the biosimilar and they are utilized quite extensively. In the UK, for instance, there are many biosimilars to etanercept and adalimumab. The cost of the biooriginal has come down because of that. It's come down significantly, in fact, but not in the United States.

RN: How can rheumatologist help patients accept biosimilars?

RF: The way the rheumatologist introduces the topic of the biosimilar and explains the topic is what's really important. If I said, “I'm going to give you a drug, because it's cheaper, it may not be quite as good, but it's cheaper,” there are [some] patients who will say, “Well, it's not quite as good, but it may work so I'll try it.” But I think most would say, “If I can afford the biooriginal, I'd rather do that.” If I [explain] that these drugs are truly similar, it's cheaper to you, and you have a 90% to 95% chance of not being able to tell the difference, I think patients will accept it. So it really is how the physician or how the health care provider explains what the biosimilar does, how similar it is to the biooriginal, and why you'd want to do it. But it's still going to come down to cost. I have friends in the United Kingdom who have had biosimilars for years. The drugs have come down from $60,000 or $70,000 a year to $2000 a year. Theoretically, more patients can get on the drug, except the British healthcare system is almost as broken as ours because you still have to have high disease activity before you can get a biologic. But in those patients, it should be much more available and more patients should be able to get on these drugs who are not on these drugs at present. I think the rheumatologist needs to understand that there's no reason not to encourage the patient to switch.

RN: What do you believe is in store for biosimilars in the United States?

RF: It depends upon what happens with our healthcare system. Right now, our healthcare system, while I still think is the best in the world, is broken. Were the rebate system to disappear, I think you’d see much more uptake of the biosimilar. If the insurance companies passed on savings, lower copays, that were more affordable to the patient, I think that they would be greatly used and there [would be] no reason why they shouldn't be used in that situation.