Cameron Santoro is an associate editor for The Center for Biosimilars

Cameron Santoro

Research finds switching from the originator to adalimumab biosimilar is safe and effective. | Image Credit: SpaceOak - stock.adobe.com

Patients with non-infectious uveitis exhibited similar clinical outcomes after switching from originator adalimumab (Humira) to 

 (Amgevita), showing that the 2 products exhibit comparable safety and efficacy as the safety of switching between adalimumab products, according to a study published in 

Once a patent ends for a medication, drug developers take advantage of nonmedical switching implementations, which is when patients swap medications for another for reasons not related to clinical outcomes—usually as a means to save money. However, some patients are not as eager to switch to biosimilars because they are fearful of potential loss of efficacy, changes in immunogenicity, and differences in safety compared with the originators.

There have been previous reports of “failed switches”, when patients request to switch back to the originator after unsuccessfully swapping to the biosimilar. However, this is usually due to adverse events that are not treatment emergent and are typically rooted in the patients’ personal preferences.

A retrospective research study was conducted among pediatric and adult patients with uveitis from 3 tertiary centers in the United Kingdom. The study was based on a mandatory change across all 3 institutions from reference adalimumab to adalimumab-atto.

There were 102 participants included in the analysis that switched from adalimumab to adalimumab-atto and had stopped adalimumab based on disease remission but began adalimumab-atto after a flare of disease within 6 months of stopping treatment.

Methotrexate was used to treat all pediatric patients but 25% stopped administration based on adverse effects, most commonly gastrointestinal-related nausea. Out of all the patients that stopped methotrexate, 88% switched to another disease-modifying antirheumatic drug (mycophenolate mofetil). 

Some pediatric patients had periods of time where they went off adalimumab but experienced flares of eye disease when restarting treatment.

After switching to adalimumab-atto, there was 1 case of worsening visual acuity and 2 events of improved visual acuity. Researchers did not find significant differences in the number flare cases or the dosage of glucorticosteroids used between the 2 groups. Less patients in the post-switch group had raised intraocular pressure compared with the pre-switch group. Flares were mild for both groups.

Around 20 patients reported experiencing adverse events after switching. The most common adverse event was an increased injection site pain (65.0%), with the majority of reports stemming from the pediatric patients (92.3%). Other adverse events reported included localized skin reactions, decreased vision, and technical issues with the injector device.

Less than half of the study population switched back to adalimumab (24.0%),most of whom were pediatric patients (n = 15/24). Only 1 patient that switched back had an allergic reaction to the biosimilar. Every patient that switched back to adalimumab did so based on individual request due to discomfort from the new injection device and never in relation to a flare in uveitis disease activity.

The authors noted the increased injection site pain in the biosimilar group may have been due to the biosimilar having a slightly larger gauge needle than the originator.

Biosimilar introduction was expected to be followed by market competition that resulted in decreased costs of development and affordability for patients. For adalimumab-atto to be considered more cost effective, the biosimilar would need to be 84% than the originator. The decrease in costs for bio-originator medications has the potential to offer low- and middle-income countries accessibility to biologics.

 annual meeting confirmed safety and efficacy when 

 patients with different types of psoriasis from reference ustekinumab (Stelara) to SB17, a ustekinumab biosimilar candidate, and reference adalimumab (Humira) to a biosimilar version (Imraldi).

 Similarly to patients with non-infectious uveitis, patients with psoriasis that had negative opinions towards biosimilars experienced nocebo effect-related adverse events after switching. 

 of physicians and patients, higher reports of disease severity, poor treatment adherence, and decreased quality of life were detected among groups that switched from an originator to a biosimilar.

Rheumatologists should be advised of the potential negative assumptions towards nonmedical switching and continuously exercise communication efforts to prevent negative outcomes caused by the nocebo effect.

Other factors that could contribute to the nocebo effect include patient reluctance to switching from medications they are satisfied with, provider’s lack of confidence in biosimilars, and the perception that biosimilars are low quality versions of originators.

Study limitations included limited in-person appointments during the COVID-19 pandemic, the pediatric patient population being from small area, and retrospective design.

The researchers concluded that more research is needed to optimize clinical considerations for patients switching from originators to biosimilars.

1. Murray GM, Griffith N, Sinnappurajar P, et al. Clinical efficacy of biosimilar switch of adalimumab for management of uveitis. 

2. Jeremias S. AAD posters examine clinical effects of switching to ustekinumab, adalimumab biosimilars. The Center for Biosimilars

. March 20, 2024. Accessed June 12, 2024. 

https://www.centerforbiosimilars.com/view/aad-posters-examine-clinical-effects-of-switching-to-ustekinumab-adalimumab-biosimilars

3. Ferreri D. Nocebo effect leads to switched patients reporting greater disease severity, poorer quality of life vs nonswitched patients. The Center for Biosimilars

. June 13, 2023. Accessed June 12, 2024. 

https://www.centerforbiosimilars.com/view/nocebo-effect-leads-to-switched-patients-reporting-greater-disease-severity-poorer-quality-of-life-vs-non-switched-patients

Articles

Switching patients with non-infectious uveitis from originator adalimumab to biosimilar adalimumab-atto was safe and effective, but some patients experienced the nocebo effect, where negative adverse events are caused by patients’ poor perception of the drug rather than the medication itself.

Switch to Adalimumab Biosimilar Safe, Effective for Uveitis, but the Nocebo Effect Persists

The Top 5 Biosimilar Articles for the Week of June 3

 (eculizumab-aeeb) as the first biosimilar to Soliris (eculizumab) for 2 rare diseases. It was also approved with interchangeability.

 of the use of adalimumab biosimilars in pediatric inflammatory bowel disease (IBD) in Sicily found “high rates” of clinical remission and treatment persistence, and no unexpected safety concerns.

 proved to be a big month for biosimilar research, particularly in the gastroenterology space, where new data on infliximab and adalimumab products from conferences and journals alike demonstrated positive clinical results showcasing the safety of these products as well as switching to them.

 evaluating switching patients from a biosimilar to another biosimilar revealed new data establishing the safety and efficacy of biosimilar-to-biosimilar switching.

Sarfaraz K. Niazi, PhD, analyzes updates to the FDA's 

, as well as the agency's increased efforts to boost biosimilar adoption and education.

To read all of these articles and more, visit 

Videos

Here are the top 5 biosimilar articles for the week of June 3, 2024. 

Here are the top 5 biosimilar articles for the week of May 27, 2024.

 Simlandi in the US; Xbrane Biopharma and STADA Arzneimitel partner with Valorum Biologics to bring a ranibizumab biosimilar to the US; Boehringer Ingelheim and Celltrion take steps to expand access to their respective adalimumab biosimilars.

 (DDW) on the ongoing LIBERTY-CD trial assessing Zymfentra, a subcutaneous infliximab product, compared with intravenous infliximab treatment in Crohn disease show the safety and efficacy of the product, as well as the impact of body mass index (BMI) on clinical outcomes.

Two posters from Digestive Disease Week found that switching patients with inflammatory bowel disease (IBD) from Remicade to an 

 did not impact clinical outcomes, with one study focusing on switches in pediatric patients and the other focusing on patients undergoing multiple switches.

Despite contributing significantly to reduced 

, biosimilars account for only about 23% of the overall biologics market, showing wide variation in uptake across different molecules, according to the IQVIA Use of Medicines in the US 

 the first 2 biosimilars referencing Eylea (aflibercept)—Yesafili (aflibercept-jbvf) and Opuviz (aflibercept-yszy)—for the treatment of ophthalmic conditions.

The Top 5 Biosimilar Articles for the Week of May 27

Top 5 Biosimilar Articles for the Week of May 20

 stressed the need for patient-centered communication and education to boost comfort with biosimilars, emphasizing consistent support from health care providers despite restrictive payer policies.

 Because of differences in how national authorities that manage drug pricing and reimbursement view health technology assessment (HTA) tools for biosimilars, there’s an urgent need for agencies to issue clear guidance on when and how to conduct HTAs for biosimilars, according to a 

 on patients with inflammatory bowel disease (IBD) switching to infliximab or adalimumab biosimilars found no change in clinical remission or antidrug antibodies after 24 weeks, but 13% experienced the nocebo effect, leading to one-fifth discontinuing therapy.

 from the Academy of Managed Care Pharmacy’s annual meeting provided hope that despite low uptake so far, adalimumab biosimilars can deliver on the promise of comparable safety and efficacy with the originator in multiple disease states as well as cost savings.

Here are the top 5 biosimilar articles for the week of May 20, 2024. 

The Top 5 Biosimilar Articles for the Week of May 20

The Top 5 Biosimilar Articles for the Week of May 13

As Indian pharmaceutical companies supplied 4 of every 10 prescriptions in the US in 2022, generating $1.3 trillion in health care savings, a new 

 highlights concerns about supply chain risks and advocates for partnerships to bolster biosimilar security and overall supply chain resilience.

 Cordavis, a CVS Healthspire company, released a 

 detailing the current hurdles faced in developing and commercializing biosimilars in the US and highlighting efforts by the organization to enhance access and affordability for these products.

 summarizes the product attributes of reference and biosimilar adalimumab products, such as formulation with or without citrate, delivery volume, and needle gauge, relevant to patients’ experience of injection-site pain.

 Biosimilars offer a promising path to affordable, effective treatment, but barriers remain for underserved communities. This 

 explores the potential of biosimilars to improve health equity while addressing the obstacles that currently prevent access.

Here are the top 5 biosimilar articles for the week of May 13, 2024. 

Illustration of person surrounded by medications | Image Credit: Geekminds - stock.adobe.com

Korean oncologists found biosimilars to be as safe and effective as originators, but paradox exists: they still tend to prescribe originators over biosimilars.

From September 2022 to October 2022, researchers collected responses from Korean oncologists who completed a web-based 

 surrounding their perspective of biosimilars and likelihood of prescribing them to patients.

 The survey was self-administered, conducted over a 15-day period, and included a total of 118 participants from the Republic of Korea. Characteristics of respondents included oncologists that worked for a 10- to 19-year period as a practicing specialist (n = 57) and those in private hospital settings (n = 80).

Biosimilars are not a new concept in the Republic of Korea; the 

 was in July 2012 for Remsima, an infliximab biosimilar.

 The Ministry of Food and Drug Safety (MFDS) approved the biosimilar for arthritis and it launched on the market in November 2012, 3 years before the first US approval.

Samsung Bioepis collaborated with Samil Pharmaceutical to deliver an aflibercept biosimilar to the market in the 

 The company was the first to have an approval for ranibizumab and aflibercept biosimilars in the Republic of Korea.

Among the survey respondents, 75.4% (n = 89) conveyed that they'd previously prescribed biosimilars to patients, 48.3% (n = 57) said they preferred originators to biosimilars, and 16.1% (n = 19) reported favoring biosimilars over originators.

 The main reason behind oncologists's preference for originators over biosimilars was the established trust in safety and efficacy of originators (94.7%; n = 54/57). However, 87% (n = 47/54) and 85.2% (n = 46/54) acknowledged the comparable efficacy and safety of biosimilars and their originators.

Cost influenced some oncologists (64.9%), with 16.1% preferring biosimilars to ease patient burden. Metropolitan doctors leaned towards originators (58.2% vs 7.6% for biosimilars), but most (56.8%) were hesitant to switch patients. Notably, 90.7% said they would switch their patients if they're experiencing financial hardship. Both public and private hospitals favored originators, but public hospitals were more open to biosimilars (23.7% vs 43.8%).

In considering biosimilars compared with originators, oncologists prioritized efficacy (95.8%) and safety (94.1%), but not patient preference (38.2%). Notably, only 16.1% said they wouldn't prescribe biosimilars to new patients.

A majority of respondents said they found similarities between the originators and biosimilars, but only found them to be “similar but not interchangeable.” Only 1.7% (n = 2/118) of respondents believed biosimilars were “interchangeable” with originators in terms of safety.

More than half of the survey population (75.4%; n = 89) had previously prescribed biosimilars to patients while 24.6% (29) reported having no experience of prescribing biosimilars at all. Some physicians replied that they switched patients from originators to biosimilars and prescribed biologic-naïve patients (30.5%; n = 36). Some respondents expressed their desire to prescribe accessible biosimilars but were faced with external barriers such as exclusion from formularies or patient resistance to them.

Common concerns that arose when switching prescriptions to biosimilars were mainly based on the efficacy of the drug (49.2%; n = 58). The primary concern was patients' trust in pharmaceutical treatments, which could lead to reduced use of biosimilars. More than half of participating oncologists emphasized the necessity of providing patients with detailed explanations regarding their medication choices (66.9%; n = 79).

The study focused on oncologists, excluding dermatology and rheumatology, through a closed-ended survey that limited generalizability and depth of insights. A small sample size, particularly from public hospitals, further restricted interpretation.

Based on the research results, the researchers concluded that patients and providers do not always make rational economic decisions because of biases that ultimately impact biosimilar adoption. To maintain competition in the market, biosimilars need to be priced considerably lower than originators.

1. Shin G, Kim BS, Kim DY, et al. Unveiling the biosimilar paradox of oncologists’ perceptions and hesitations in South Korea: A web-based survey study. 

https://doi.org/10.1007/s40259-023-00640-3

2. Biosimilars approved in South Korea. Generics and biosimilars initiative. March 26, 2021. Accessed May 6, 2024. 

https://gabionline.net/biosimilars/general/Biosimilars-approved-in-South-Korea

3. Jeremias S. Samsung Bioepis announces new biosimilar partnership, regulatory updates. The Center for Biosimilars. February 27, 2024. Accessed May 6, 2024. 

https://www.centerforbiosimilars.com/view/samsung-bioepis-announces-new-biosimilar-partnership-regulatory-updates

A Korean survey found that while most oncologists believe biosimilars are just as safe and effective as originator drugs, they often prescribe the originators due to factors like lack of patient trust in biosimilars and lower than expected cost savings. 

Survey Finds Korean Oncologists Trust Biosimilars But Prescribe Originators More

Jeffrey Casberg, RPh, MS. 

Jeffrey Casberg, RPh, MS, senior vice president of pharmacy at 

 mentions several drugs due to lose patent exclusivity soon, which would allow generic versions to be produced. Casberg discusses biosimilar competition, a relatively new phenomenon in the pharmaceutical industry that could lead to significant price reductions.

He highlighted various types of medications, ranging from oncology treatments, to diabetes, inflammatory diseases, and age-related macular degeneration. Casberg suggests stakeholders remain vigilant of these patent expirations in the upcoming year or couple of years as he and other experts work to analyze and determine drug life cycle insights to predict future market shifts.

With brand patents expiring, which products about to face upcoming generic and biosimilar competition do you think stakeholders should be keeping their eye on?

Yeah, there are a couple products coming down the road that would be losing exclusivity. The first one I'll hit is 

 [liraglutide], it's a GLP-1 [inhibitor]. You can't talk about pharmaceuticals today without talking about GLP-1 [inhibitors] and weight loss.

So, Victoza was kind of a big advance back in its day. It was the first once daily GLP-1 [inhibitor], once daily subcutaneous administered injectable product. It has less nausea associated with it than its previous predecessor, 

 [exenatide]. It was also the first GLP-1 [inhibitor] that had cardiovascular positive studies for cardiovascular effect. Great drug but I don't see it really helping with this whole GLP-1 [inhibitor] shortage and weight loss issue.

 [dulaglutide], they both have about 50% the weight loss that 

 [tirzepatide] have so I don't see all of a sudden a big rush to go to Victoza generic because number 1: it's once a day, and number 2: it doesn't have the weight loss that some of the big products that you're hearing about every day have. So, that's Victoza, that'll be coming shortly here in June. I think there could be quite a few generics.

 [dasatinib]. They're both tyrosine kinase inhibitors similar to 

 [imatinib mesylate], great drugs in oncology, pretty expensive therapies, and we should get quite a few generics and a good amount of price reduction there.

Then moving over to the biosimilars side, 

 [ustekinumab] biosimilars are coming. Everybody's been talking about 

 [adalimumab] and 9 or 10 companies bringing those [biosimilars] to market but almost just as big, Stelara is a big drug—$15 to $20 billion product—and it also has 8 or 9 manufacturers lined up to bring products to market. We'll have to see if the adoption by payers is similar or quicker, we're just starting to have some success and conversion of Humira to biosimilars. We'll have to see how the payers adopts Stelara [biosimilars]. Maybe they've gained some more confidence and learned a little bit from the Humira introduction. We'll have to see and Stelara will be coming early in 2025. Amgen has the first product out but then pretty quickly thereafter, several other products will hit.

 [aflibercept] biosimilars in the ophthalmology area, for age-related macular degeneration. We had 

 [ranibizumab] biosimilars come out with a couple of biosimilars recently and those biosimilars have done pretty well.

Eylea, we're watching, we don't know if it's going to come out this year, or in a year or 2. There's an opportunity this year, but IPD, the company I work for does a lot of predicting of this and we think it actually may not be in 2024, it might be 2025 or 2026 before we get Eylea, but watch for that. I had mentioned Victoza, Trulicity is a $16 billion GLP-1 [inhibitor], and it's biosimilar [could be] out in 2027. Something to plan for by the payers.

Jeffrey Casberg, RPh, MS, examines upcoming generic and biosimilar competition in the pharmaceutical industry, showcasing certain drugs that will face competition soon. 

Jeffrey Casberg Predicts Generic, Biosimilar Competition in the Pharmaceutical Market

The Top 5 Biosimilar Articles for the Week of May 6, 2024. 

 showed some misalignment in payer coverage of granulocyte colony-stimulating factor (G-CSF) biosimilars, highlighting that while filgrastim biosimilars are often favored over the originator, reference pegfilgrastim still dominates over its biosimilars.

The FDA approved a high-concentration, citrate-free version of Boehringer Ingelheim’s 

, making it the second high-concentration adalimumab biosimilar to have an interchangeability designation.

 The approval marks the sixth for a biosimilar referencing 

 for the treatment of HER2-positive breast and gastric cancers.

 During her presentation during Festival of Biologics USA, 

, PharmD, director of formulary management at Sutter Health, gave an overview of current challenges and opportunities for the biosimilar market and offered calls to action for multiple stakeholders.

Here are the top 5 biosimilar articles for the week of May 6, 2024. 

The Top 5 Biosimilar Articles for the Week of May 6

Health equity chart. Image Credit: leowolfert - stock.adobe.com

Over the past decade, biosimilars have emerged as a transformative force within the pharmaceutical landscape. Initially introduced in Europe, they have steadily gained traction in the United States, proposing an increased patient access to life-saving medications at lower costs.

Biosimilar development hinges on rigorous scientific comparisons. Extensive data analysis, including clinical pharmacokinetic similarities, forms the backbone of these evaluations. Biosimilars undergo meticulous scrutiny to ensure they match the efficacy, safety, and immunogenicity profile of their brand name counterparts.

 Ultimately, FDA approval signifies that no clinically meaningful differences exist between the biosimilar and the originator biologic drug.

However, a concerning trend has emerged, with clinician familiarity of biosimilars falling below expectations, hindering their prescription rates. Given their cost effectiveness and near identical characteristics to brand name drugs, why are biosimilars not achieving the market adoption they deserve?

, brought to you by The Center for Biosimilars

. We will delve into the potential of biosimilars to empower underserved communities while dissecting the obstacles that currently prevent them from accessing these affordable treatments.

Our series, titled "Unlocking the Potential of Biosimilars to Improve Health Equity," will shed light on the significant knowledge gaps within the medical field. The 2-part series kicks off by exploring medical mistrust in underserved communities and the knowledge gaps created by critical barriers faced by both patients and healthcare professionals. In part 2, focus is shifted on the role of payers, pharmacy benefit managers, and the financial incentives that influence prescription choices.

Biosimilars hold promise for affordable treatment options while maintaining the same safety and efficacy compared with their originators, but barriers from pharmacy, physician, and insurance groups limit patient access to health equity, especially for underserved communities.

Biosimilars: Affordable, Effective Treatments

Patient access to biosimilars allows earlier treatment access which can result in improved outcomes by controlling symptoms and reducing symptom severity. Biosimilar sales are typically priced 11% to 45% lower than originators and promote considerable savings for eligible patients.

 Since the Biologics Price Competition and Innovation Act (BPCIA) of 2009 was passed, biosimilars have generated $37 billion in savings, despite slow uptake in some markets.

As more biosimilars launch and experience increased uptake, losses for originator products are expected to rise from $111 billion to $192 billion by the end of 2028.

 In its Global Use of Medicines report, the IQVIA Institute for Human Data Science estimated the spending on reference products will decrease $39.5 billion over the next 5 years thanks to biosimilar competition. The future holds significant promise for biosimilars with global use potentially growing to 3.8 trillion daily doses by 2028, an overall 400 million increase compared with 2023.

In an interview with The Center for Biosimilars, Robert Popovian, Pharm.D, MS, a health economist, and founder of Conquest Advisors, stated, “We need to address benefit design. Over the last 10 years there’s been coinsurances and deductibles introduced in the benefit design for biopharmaceuticals. Because of that, [drug prices] are a little bit of an unknown.”

While the potential advantages of biosimilars are undeniable, realizing their full impact can be a complex process with the current policies in place. To ensure biosimilars can provide all patients with adequate care and savings, stakeholders will need to address some of the challenges that exist and propose potential solutions for navigating them effectively.

In the US, people without health insurance often have trouble accessing affordable health care. One study found non-White populations were 70% more likely to not have health insurance in comparison to their Caucasian counterparts.

 In addition, geographic areas that have limited access to doctor’s offices and other facilities had higher populations of non-White communities. Black families were also twice as likely as White families to live in poverty, making an average of $52,860 yearly income compared with $81,060 for non-Hispanic White annual income.

White people living among rural populations are also affected by inadequate health care at higher rates compared with White people living in urban areas. With one-fifth of the American population occupying rural regions, local hospitals and access to care are limited.

 From 2013 to 2020, about 4% of rural hospitals closed in the US, leaving residents with 20 miles to 40 miles of travel.

Biosimilars are intended to offer effective treatments to various communities and illnesses no matter their financial status. With the emergence of self-injectable and on-body drug administration options for biosimilars, patients can reduce their dependence on hospital facilities and drug delivery related health care costs.

Subcutaneous administration is significantly beneficial by making drug delivery less time consuming for patients from underserved communities as many of these patients with conditions requiring biologic therapies are unemployed or working part-time based on the severity of their condition. This option helps patients living further from the hospital or those who do not have a reliable means of travel. Minimizing travel can also reduce the risk of exposure to hospital-acquired infections among patients and any accompanying companions.

Considering the financial inequalities non-White communities face, biosimilar competition proposes lower costs for the whole market, including the reference product. Systemic evidence found competition has resulted in marginal price decreases, with biosimilars being priced only about 30% less than their originators.

 Overall, this represents an average discount of $665 off the typical price. Biosimilars offer the potential for significant cost savings, with research suggesting a 4.3 times higher savings rate compared with generics. However, the question of whether these savings translate directly to patient affordability remains complex and will be explored further in part 2 of this series.

Medical Mistrust Leads to Treatment Hesitancy

Biosimilars have the potential to promote greater accessibility and affordability to non-White populations, but current access is limited due to factors like medical mistrust and racial inequalities in health care. Historically, underserved populations endured various forms of medical malpractice, specifically Black people. Ultimately, this has led to loss of trust among non-White communities, racial prejudices in the health care sector, and a neglect in treatment for these populations.

In a Canadian study, Black patients were found to be less likely to receive biologic treatment for several medical conditions.

 The US sees similar patterns as there is a lot of medical mistrust among Black communities, stemming from a long history of unethical medical practices that have harmed them. Some of the most prominent, documented forms of medical malpractice were conducted on enslaved women by James Marion Sims, MD, between 1845 to 1849, who is now referred to as “the father of gynecology.”

 Sims operated on his participants, often enrolled by their enslavers, without anesthesia because he was under the racist belief that “Black people did not feel pain.”

Almost 100 years later, unethical medical malpractice continued throughout the 1930s, notably the Tuskegee experiment, which is often cited as a major stimulus for the mistrust of medical advances among Black populations.

 Similarly to the enslaved women, some 600 African American participants did not express informed consent and were not offered treatment if infected with syphilis, despite medical advancements becoming widely available.

Additionally, the little representation of Black and Indigenous health care workers is not nearly equivalent to other races. Unequal access to quality health care and a history of mistreatment has led to a gap in trust when it comes to new medical developments for underserved populations.

The mistrust non-White communities have towards health care professionals contributes to biologic treatment hesitancy. In a US study, results found higher levels of unfamiliarity of biologic therapies in Black patients compared with White patients.

 The knowledge gaps non-White communities have towards biologics or false information is largely due to the lack of comfort they have in asking health care professionals and trusting the feedback they receive.

Racial inequalities Black patients experience resulted in the decreased likelihood they would receive reference trastuzumab for breast cancer treatment. Trastuzumab, a biologic rapidly growing in US cancer care, holds potential for the reduction of health care inequalities but often dismisses marginalized communities in study populations.

Clinical trials aim to prove the safety and effectiveness of biosimilars, but the health care system has low participation of non-White populations, furthering their medical mistrust. A study found only 2.6% of global cancer clinical trials included Black participants.

 Aside from general representation, demographic variety is important because it reveals any inter-ethnic differences in drug responses and metabolism. This lack of representation in clinical trials can only be addressed if there is a significant shift in how health care builds trust with minority communities.

Additionally, the lack of transparency pharmacy benefit managers (PBMs) have with patients furthers this medical mistrust. The 3 PBMs that control around 80% of the market are CVS Caremark, Express Scripts, and Optum Rx, which are all operated by major health insurers and/or owned by a pharmacy.

 These PBMs are ultimately negotiating with themselves or 1 of their competitors to create financial incentives that benefit themselves while negatively impacting patients.

Chiara Gasteiger, PhD, of Stanford University’s Mind and Body Lab researching as a postdoctoral scholar explained in an interview, “To combat trust issues among patients, providers, and physicians, there needs to be more transparency on the role of PBMs [pharmacy benefit managers], their negotiation processes and disclosure of rebate retentions to build trust and understanding from stakeholders, health care providers, and policymakers. Existing regulations should also ensure that PBMs comply with laws that protect patients and encourage fair pricing.”

Transparency around PBMs is crucial and these efforts must be coupled with addressing the everyday challenges faced by patients that create mistrust, particularly in underserved communities. Bureautic hurdles, such as language or health literacy, disproportionately affect underserved communities in several ways. A 2020 survey on race and health revealed 20% of both Black and Hispanic adults reported unfair treatment based on race or ethnicity in health care within the past year.

 In a separate survey from 2021, 24% of Hispanic adults expressed it was “very” or “somewhat difficult” to find a physician that was able to explain things in a way they could easily understand.

Underserved communities, burdened by limited advocacy, finances, and often low health literacy, struggle to access essential medications. Biosimilars, offering comparable treatments at lower costs, can empower these communities towards better health outcomes.

Popovian described a study he participated in where he found, “it's not just health literacy and education of patients. It's also health literacy and education of health care providers,” in reference to the existing knowledge gaps surrounding biosimilars.

Further communication between physicians and patients would allow underserved, underrepresented communities to establish a level of trust with health care systems. Language barriers include complicated medical terminology, differing dialects between patient and physicians, and providers often being unable to communicate in non-native English speakers’ primary languages. 

Gasteiger suggested, “Information should be presented in a language and communication style that aligns with the patient’s health literacy and cultural norms, including the option to have a support person present.” It is up to health care systems to work with the patient and their caregivers on the status and severity of the patient’s condition and potential treatment options.

Gasteiger argued that physicians building rapport with their patients helps establish trust, enabling open dialogue about concerns, especially when providers are transparent about funding limits. Bridging knowledge gaps and addressing the evolving needs of each unique patient and their families must be tailored through collaboration, reiteration, and flexibility among providers.

She suggested “Transparent patient and family-centered communication and shared decision-making should be encouraged to build trust and promote patient autonomy. Small nudges can also be used to encourage more positive perceptions of biosimilars, such as through positive message framing and carefully balancing risk benefit information.

With the little representation of most underserved communities, health care providers can seem intimidating to certain patients, ultimately preventing them from participating in the decision-making process. Furthermore, increased access to information in the modern age leads to an increased risk of spreading misinformation, leaving vulnerable populations at risk for false theory consumption.

“It is important to empower patients to identify misinformation and provide credible supportive material. Implementing more guidelines for media reporting on biosimilars could further help to combat misinformation,” Gasteiger stated.

Gaining multiple opinions and expanding research upon treatments can be beneficial in educating patients and physicians. The FDA website has multimedia educational resources on biosimilars and interchangeable products for patients, caregivers, and health care providers.

 These materials are available in multiple formats and languages. Fortunately, some of the educational resources are also offered through videos, an important factor for populations with low literacy rates.

“More education, such as on testing and manufacturing, needs to be integrated into medical training curriculums and all providers should have access to comprehensive training programs that are regularly updated with new designations, guidelines, and policies,” Gasteiger suggested as a solution.

Popovian commented, “We need to do quite a bit of education but it's super important to be able to do it both on the health care professional side and on the patient side. It's also important to understand that especially that education is important for patients on chronic care medicines that they've been taking for very long.”

Through collaborative communication, culturally sensitive education, and a commitment to shared decision-making, health care providers can unlock the potential of biosimilars for underserved communities, empowering patients to make informed choices about their health.

1. Shubow S, Sun Q, Nguyen Phan AL, et al. Prescriber perspectives on biosimilar adoption and potential role of clinical pharmacology: A workshop summary. 

. 2023;113(1):37-49. doi:10.1002/cpt.2765

2. Jeremias S. IQVIA predicts biosimilar, generic competition will cost originators $192 billion by 2028. Drug Topics. January 19, 2024. Accessed March 29, 2024. https://www.drugtopics.com/view/iqvia-predicts-biosimilar-generic-competition-will-cost-originators-192-billion-by-2028

3. Health O of M. Advancing better health through better understanding for black and african american communities: Health literacy, health care access, and culturally appropriate care 2024 reading list. www.hhs.gov.

January 30, 2024. Accessed March 29, 2024. https://www.hhs.gov/black-history-month/readinglist/index.html#:~:text=Black%20households%20are%20twice%20as

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7. Akuffo-Addo E, Udounwa T, Chan J, Cauchi L. Exploring biologic treatment hesitancy among black and indigenous populations in Canada: a review. 

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8. Holland B. The “father of modern gynecology” performed shocking experiments on slaves. History.com. Published December 4, 2018. Accessed March 29, 2024. https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experiments-on-slaves

9. Petrullo J. Biosimilars can expand treatment access for traditionally excluded communities. Center for Biosimilars. July 18, 2023. Accessed March 29, 2024. https://www.centerforbiosimilars.com/view/biosimilars-may-expand-treatment-access-for-traditionally-excluded-communities

10. Hearing wrap up: Pharmacy benefit managers push anticompetitive drug pricing tactics to line their own pockets - United States house committee on oversight and accountability. Press release. United States House Committee on Oversight and Accountability; October 2, 2023. Accessed April 25, 2024. https://oversight.house.gov/release/hearing-wrap-up-pharmacy-benefit-managers-push-anticompetitive-drug-pricing-tactics-to-line-their-own-pockets%EF%BF%BC/#:~:text=But%20that%20environment%20of%20competition,is%20owned%2C%20by%20a%20pharmacy.

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Biosimilars offer a promising path to affordable, effective treatment, but barriers remain for underserved communities. This 2-part series explores the potential of biosimilars to improve health equity while addressing the obstacles that currently prevent access.

Part 1: Unlocking the Potential of Biosimilars to Improve Health Equity

The Top 5 Biosimilar Articles for the Week of April 29. 

Here are the top 5 biosimilar articles for the week of April 29, 2024. 