Use of Biologics Vs Biosimilars For Rheumatoid Arthritis

Transcript: Madelaine A. Feldman, MD: If the question is how often we change from an originator to a biosimilar, I think we realize that they work very similarly. So if the originator or the reference product biologic is not working, I don’t envision many rheumatologists switching to a biosimilar. We don’t expect it to work any worse, but we don’t expect it to work any better. Switching from originators to biosimilars does happen, but generally that happens because of third-party considerations.

If a patient can get the benefit of lower cost from a biosimilar and there is a question of starting them on a higher-priced originator or a lower-priced biosimilar, I will always, and I think this is the tendency among rheumatologists, go with the drug that costs the patient the least. If it’s an infusion that doesn’t necessarily cost the physician or the insurance company the least, but if the patient can benefit from a lower price or a lower cost-share with a biosimilar, all things being equal with the reference product and the biosimilar, I think rheumatologists would choose the lower-cost alternative.

I’ve never been forced to switch from a biosimilar to an originator. There are formularies that are coming out now where the biosimilar may be preferred over the originator. Therefore, the patient will need to be switched to the biosimilar. I don’t think it’s been around long enough, at least in the formularies that my patients have been on, where the patient was on a biosimilar and then would have to switch back to the reference product. One would be preferred over the other at that point.

We don’t have any self-injectable biosimilars yet, so we’re really looking at provider-administered drugs at this point. I have not come across any formularies that have switched from a biosimilar to a reference product as of yet. I’m sure it will happen.

Transcript Edited for Clarity