Only half of rheumatologists are “extremely comfortable” prescribing the Humira biosimilar Amjevita, while just 16% can say the same for all other adalimumab biosimilars combined, according to a market analysis from Spherix Global Insights.
For reference, 83% of rheumatologists included in the analysis reported being “extremely comfortable” prescribing originator Humira (adalimumab, AbbVie). This yawning gap underscores how rheumatologists, who have grown comfortable with an increasing array of biologic medications, now face the challenge of navigating a complicated biosimilar landscape. And in such a landscape, nonmedical considerations like formulary placement can potentially sway prescribing habits throughout multiple specialties.
“Formulary placement is extremely important for patient access and likely physician experience and familiarity,” Amelia Bond, PhD, a health economist and assistant professor in the department of population health studies at Weill Cornell Medical College, in New York, told Healio.
Spherix Global Insights conducted the market analysis in November 2023, in which 76 rheumatologists, 82 gastroenterologists and 78 dermatologists were surveyed about various topics pertaining to biologic and biosimilar prescribing habits.
Topline results showed that while 83% of rheumatologists were “extremely comfortable” prescribing adalimumab originator Humira, just 55% were extremely comfortable with the biosimilar Amjevita (adalimumab-atto, Amgen) and only 16% were extremely comfortable with all other Humira biosimilars combined.
According to Bond, who was not involved in the Spherix analysis, all three major pharmacy benefit managers (PBMs) — Optum, Express Scripts, which is now Evernorth, and CVS Caremark — included Amjevita in their national formulary upon launch, in January 2023, at parity with their placement of Humira.
Later, in July 2023, these PBMs added a few of the other biosimilars that had launched in the intervening period. Optum and Express Scripts included Cyltezo (adalimumab-adbm, Boehringer Ingelheim) and both formulations of Hyrimoz (adalimumab-adaz, Sandoz) — original and citrate free — while Caremark included the two Hyrimoz formulations and Hadlima (adalimumab-bwwd, Samsung Bioepis).
“Amjevita’s launch 6 months ahead of the entry of the next seven biosimilar launches likely helped with formulary placement and more generally helped to differentiate the product from the others,” Bond said.
Despite this early trend, Bond added that she is confident that ongoing approvals will lead to future changes in prescribing habits.
“It is possible that perception may change as PBM formularies change,” she said, noting that CVS Caremark removed Amjevita from its preferred formulary placement in January.
However, there may be one other factor not covered by the Spherix service that is impacting prescribing, according to Bond.
“It may be worth exploring concepts like physician detailing and advertisement spending,” she said.
As formularies shift and change, and familiarity with various products increases, physician comfort levels with specific medications is also likely to change.
Acute vs. chronic treatment
Further results from the Spherix analysis showed that 36% of rheumatologists were “somewhat comfortable” prescribing Amjevita, while 41% of gastroenterologists and 50% of dermatologists were somewhat comfortable with this medication.
Meanwhile, the majority of physicians — 62% each for rheumatologists and gastroenterologists and 54% of dermatologists — were only somewhat comfortable prescribing all other biosimilars combined.
“From qualitative interviews with pharmacists and hospital purchasing managers, it is my understanding that certain specialties encounter new drugs on a regular basis and are therefore generally more open to new drugs including biosimilars,” Bond said. “Rheumatologists and gastroenterologists were specialists our interviewees pointed to as being less inclined to biosimilars relative to oncologists.”
Some of this trend in comfort levels may be attributed to acute needs like cancer treatment compared with chronic needs like rheumatoid arthritis, according to Bond.
“Once a patient is on chronic medication, a physician may be less inclined to switch, whereas acute episodes are generally shorter in duration and new patients start on medications relatively regularly,” she said.
The implication is that continuous cycling of new medications will make specialists in oncology more familiar with a broader range of products.
Another factor that correlates to physician comfort with a product is their ability to recall the product’s name, drug class or other information about it.
Spherix services suggest that when unaided, physicians in all three specialties were most likely to recall Amjevita. The second and third products both rheumatologists and gastroenterologists could best recall were Cyltezo followed by Hadlima. The second and third products dermatologists could best recall were Hulio (adalimumab-fkjp, Fujifilm Kyowa Kirin Biologics) and then Yusimry (adalimumab-aqvh, Coherus Biosciences).
“There are two items I will note about this,” Bond said. “First, Amjevita was launched in January 2023, whereas the next seven Humira biosimilars to come to market were launched at the same time in July 2023. This gave Amjevita 6 months of biosimilar market exclusivity, likely leading in part to it placing first on the list.”
Bond’s second point pertained to the hot-button topic of interchangeability.
“Cyltezo was launched in the second wave of Humira biosimilars, in July 2023, and was the first Humira biosimilar to receive an interchangeability designation from the FDA, which differentiates this product from all others currently on the market,” she said. “This could be why Cyltezo is second on this list.”
Launches get ‘neutral’ marks
As part of the survey, Spherix asked providers about their thoughts regarding the launch of individual Humira biosimilar products. In general, Humira biosimilar manufacturers mostly received “neutral” launch ratings, according to the findings, while Amjevita received the highest marks. Dermatologists were less likely than physicians in the other two specialties to be impressed with the launch of Humira biosimilars.
Although Bond did not want to comment on the nature of product launches, she reiterated the importance of launch timing relative to other products as a possible reason for Amjevita’s strength in this category.
“Pricing and negotiations with PBMs are also important for formulary placement,” she said.
Additional data from the analysis covered citrate-free formulations of these medications, which are enjoying a growing market share. Despite not being a prescribing physician, Bond echoed the sentiments of many clinicians and noted that both patients and providers have grown to prefer the citrate-free versions due to a reduced incidence of injection-site reactions.
“There is general agreement in the health policy community that the citrate free formulation was an example of AbbVie engaging in patent evergreening,” she said. “Meaning, this would extend the years of Humira exclusivity.”
Bond added that there was some concern that AbbVie’s introduction of a citrate-free formulation in 2018, after a 2015 approval, was a tactic to delay citrate-free biosimilars being approved in the United States.
“It appears that most biosimilars were able to successfully gain approval for this formulation,” she said.
References:
Special Topix: Rheumatology, Gastroenterology, Dermatology Biosimilars Today and Tomorrow (US) Q4 2023. https://www.spherixglobalinsights.com/rheumatology/. Published Dec. 15, 2023. Accessed Feb. 14, 2024.
Source: Healio: https://www.healio.com/news/rheumatology/20240411/amjevita-leads-humira-biosimilars-in-clinician-comfort-as-rheumatologists-remain-wary
