Previous studies of stakeholder perceptions have primarily focused on physicians. However, pharmacists are key stakeholders in the use and adoption of biosimilars. The study carried out by Stevenson et al. sought to gain insights from US pharmacists about their knowledge and approach to the use of biosimilars.
Biosimilars are of increasing significance, with the potential to improve patient access to biological therapies and help reduce overall healthcare cost.
A web-based survey of pharmacists from a range of practice settings was conducted between 8‒13 March 2021 . Members of a Medscape.com panel were randomly invited to participate in an online questionnaire fielded by WebMD LLC. All were in practice for at least one year in community, home care or infusion, hospital or health system, managed care, outpatient, or specialty pharmacy settings. A target sample size of 500 respondents was set with regional representation.
There were 992 respondents to an email invitation to participate. 265 did not meet eligibility criteria and 220 responded after the survey had closed. Data were reported for the remaining 507 respondents. 66% worked in a community pharmacy setting; 16% practiced in an outpatient clinic or other setting; 14% in hospitals or health systems; and 5% in managed care.
Respondents indicated a high degree of confidence in the FDA approval process. Approximately 90% responded positively to statements that biosimilars have clinically similar efficacy and safety as the reference product.
When asked if it is appropriate for a pharmacist to dispense an interchangeable biosimilar in place of its reference product without authorization from the prescriber (if consistent with state law), only 53% responded affirmatively.
When presented a list of 12 biosimilars (none of which were approved as interchangeable at the time), only 23%‒33% of respondents correctly identified that the individual biosimilars were not designated as interchangeable, and only 11% of respondents correctly identified that none of the biosimilars listed were interchangeable.
Regarding the naming of biosimilars, 81% of respondents reported that they would cite the National Drug Code (NDC) number when reporting an adverse drug event. Respondents preferred to use both the non-proprietary name (core plus 4-letter suffix) and the brand name when communicating with prescribers. This was also a common strategy when communicating with patients; although, the most common practice with patients was to communicate the brand name only (49%). Citing both the brand name and the non-proprietary name was the preferred way to differentiate reference products and biosimilars in electronic ordering, dispensing and administration systems (61% of respondents).
When presented with a prescription for the generic core name only, e.g. adalimumab, and both biosimilars and the reference product are available, 67% stated that they would contact the physician to clarify which product was intended. However, 24% stated that they would automatically dispense a lower cost biosimilar. When asked about the factors that influenced their decision to stock products, ‘patient financial burden’ and ‘payer preference’ were most prominent.
Only slightly more than half of respondents reported that they were ‘moderately’ or ‘very’ comfortable responding to questions from patients about biosimilars. Most responded that they did not routinely involve patients in the decision to start therapy with or change to a biosimilar.
Accordiing to Stevenson et al., the major knowledge gaps identified in this study centred around clinical, legal and regulatory aspects of interchangeability and substitution. Interchangeability as a regulatory standard is specific to the US. These knowledge gaps may have contributed to pharmacists’ lack of comfort in speaking with patients about biosimilars.
The survey provides insights regarding US pharmacists’ knowledge gaps surrounding biosimilars and should guide further educational initiatives to support the optimal use and adoption of biosimilars.
Conflict of Interest
This study was funded by Boehringer Ingelheim Pharmaceuticals, Inc.
James G Stevenson reported participating on an advisory board for Boehringer Ingelheim. Other authors of the research paper  declared that there was various conflict of interest. For full details of the authors’ conflict of interest, see the research paper .
Abstracted by Emeritus Professor James G Stevenson, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
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1. Stevenson JG, McCabe D, McGrath M, et al. Pharmacist biosimilar survey reveals knowledge gaps. J Am Pharm Assoc (2003). 2022;S1544-3191(22)00381-8.
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