Market Research for the Pharmaceutical Benefits Schedule (PBS) and Biosimilar Medicines

Quantitative – Report

Market Research for the PBS and Biosimilar Medicines: December 2016

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Sponsor: National Medicines Policy Section

Department of Health

Australian Government

Authors: Shannon Coughlin

ORC International Ref: 3000290 Report

ORC International

Level 8, 171 La Trobe Street

Melbourne Vic 3000 Australia

Version: 1.0

Release Date: December 2016

Contents 4

1 Executive Summary 10

1.1 Professional stakeholders 10

1.2 Consumers 12

1.3 Conclusions and recommendations 13

2 Introduction 18

3 Objectives 19

4 Methodology 20

4.1 Quantitative benchmark research 20

4.2 Profile of target audiences 22

4.3 Reporting conventions 27

5 Key Findings: Professional Stakeholders 29

5.1 About this chapter 29

5.2 Familiarity with biologic and biosimilar medicines 29

5.3 Prevalence of prescribing/dispensing biologic and biosimilar medicines 33

5.4 Sources of awareness: biologic and biosimilar medicines 34

5.5 Advantages and disadvantages of biosimilars 43

5.6 Confidence in prescribing/dispensing biosimilar medicines 51

5.7 Intention to switch/use/accept biosimilar medicines 73

5.8 Understanding of the PBS 80

6 Key Findings Consumers 84

6.1 About this chapter 84

6.2 Familiarity with biologic and biosimilar medicines 85

6.3 Prevalence of use of biologic and biosimilar medicines 88

6.4 Sources of awareness: biologic and biosimilar medicines 89

6.5 Advantages and disadvantages of biosimilar medicines 96

6.6 Confidence in taking biosimilar medicines 100

6.7 Intention to switch/use/accept biosimilar medicines 118

6.8 Understanding of the PBS 122

7 Conclusions & Recommendations 126

7.1 Professional stakeholders 127

7.2 Consumers 130

Appendix A: Specialist questionnaire 131

Appendix B: GP questionnaire 146

Appendix C: Pharmacist questionnaire 160

Appendix D: Consumer questionnaire 175

Table of Figures

Figure 1: Specialist overview diagram 12

Figure 2: GP overview diagram 13

Figure 3: Pharmacist overview diagram 14

Figure 4: Consumer overview diagram 15

Figure 5: Years of experience 20

Figure 6: Location 21

Figure 7: Capital city or regional location 21

Figure 8: Area of specialisation 22

Figure 9: Length of time since diagnosis 22

Figure 10: Location 23

Figure 11: Capital city or regional location 23

Figure 12: Associated conditions - patients 24

Figure 13: Associated conditions - carers 24

Figure 14: Type of person cared for - carers 25

Figure 15: Familiarity with biologic medicines 28

Figure 16: Familiarity with biologic medicines – sub group differences 28

Figure 17: Familiarity with biosimilar medicines 29

Figure 18: Familiarity with biosimilar medicines – sub group differences 29

Figure 19: Familiarity with biologic and biosimilar medicines - comparison 30

Figure 20: Prescribed/dispensed biologic or biosimilar medicines 31

Figure 21: Prescribed/dispensed biologic or biosimilar medicines – sub group differences 31

Figure 22: All sources of awareness biologic medicines – sub group differences 34

Figure 23: All sources of awareness biosimilar medicines – sub group differences 37

Figure 24: Barriers and benefits of biosimilar medicines 42

Figure 25: Barriers and benefits of biosimilar medicines – sub group differences 43

Figure 26: Barriers to prescribing/dispensing biosimilar medicines – sub group differences 45

Figure 27: Benefits to prescribing/dispensing biosimilar medicines – sub group differences 48

Figure 28: Unprompted confidence prescribing/dispensing biosimilar medicines 52

Figure 29: Unprompted confidence prescribing/dispensing biosimilar medicines – sub group differences 52

Figure 30: Prompted confidence prescribing/dispensing biosimilar medicines 54

Figure 31: Prompted confidence prescribing/dispensing biosimilar medicines – sub group differences 54

Figure 32: Unprompted and prompted confidence prescribing/dispensing biosimilar medicines - comparison 55

Figure 33: Confidence in efficacy of biosimilar medicines 56

Figure 34: Confidence in efficacy of biosimilar medicines – sub group differences 56

Figure 35: Confidence in comparability of biosimilar medicines 57

Figure 36: Confidence in comparability of biosimilar medicines – sub group differences 57

Figure 37: Confidence in the efficacy and comparability of biosimilar medicines - comparison 59

Figure 38: Comfort prescribing/dispensing biologic medicines 60

Figure 39: Colleague recommendation 61

Figure 40: Biosimilars and confidence in Australia’s regulatory processes 62

Figure 41: Biosimilars and medication access programs 63

Figure 42: Biosimilars are essentially the same as generic medicines 64

Figure 43: Awareness of PBACs decision making processes 65

Figure 44: Impact of biosimilars 66

Figure 45: Biosimilars and biologic-naive patients 67

Figure 46: Biosimilars and biologic-stable patients 68

Figure 47: Biosimilars and cost-effectiveness 69

Figure 48: Biosimilars and sustainability of the PBS 70

Figure 49: Attitudes to biosimilar medicines – specialist sub group differences 70

Figure 50: Attitudes to biosimilar medicines – GPs sub group differences 72

Figure 51: Attitudes to biosimilar medicines – Pharmacists sub group differences 73

Figure 52: Confidence switching a patient 75

Figure 53: Confidence switching a patient – sub group differences 75

Figure 54: Confidence counselling a patient 76

Figure 55: Confidence counselling a patient – sub group differences 77

Figure 56: Feelings about substitution - detail 78

Figure 57: Feelings about substitution - summary 78

Figure 58: Feelings about substitution – sub group differences 79

Figure 59: Confidence in medicine regulation 82

Figure 60: Confidence in medicine regulation – sub group differences 82

Figure 61: Need to increase understanding of the PBS 83

Figure 62: Need to increase understanding of the PBS – sub group differences 83

Figure 63: Familiarity with biologic medicines 87

Figure 64: Familiarity with biologic medicines – sub group differences 87

Figure 65: Familiarity with biosimilar medicines 88

Figure 66: Familiarity with biosimilar medicines – sub group differences 88

Figure 67: Familiarity with biologic and biosimilar medicines - comparison 89

Figure 68: Used biologic or biosimilar medicines 90

Figure 69: Used biologic or biosimilar medicines – sub group differences 90

Figure 70: All sources of awareness of biologic medicines – sub group differences 92

Figure 71: All sources of awareness of biosimilar medicines – sub group differences 95

Figure 72: Barriers and benefits of biosimilar medicines 98

Figure 73: Barriers and benefits to taking biosimilar medicines – sub group differences 98

Figure 74: Potential benefits to taking biosimilar medicines – sub group differences 101

Figure 75: Unprompted confidence taking biosimilar medicines 103

Figure 76: Unprompted confidence taking biosimilar medicines – sub group differences 103

Figure 77: Unprompted and prompted confidence taking biosimilar medicines - comparison 104

Figure 78: Prompted confidence taking biosimilar medicines – sub group differences 104

Figure 79: Confidence in effectiveness of biosimilar medicines 105

Figure 80: Confidence in effectiveness of biosimilar medicines – sub group differences 105

Figure 81: Confidence in comparability of biosimilar medicines 106

Figure 82: Confidence in comparability of biosimilar medicines – sub group differences 106

Figure 83: Confidence in the effectiveness and comparability of biosimilar medicines - comparison 107

Figure 84: Comfort with biologic medicines 108

Figure 85: Other people’s recommendation 109

Figure 86: Biosimilars and confidence in Australia’s regulatory processes 110

Figure 87: Biosimilars and medication access programs 111

Figure 88: Biosimilars are essentially the same as generic medicines 112

Figure 89: Awareness of PBACs decision making processes 113

Figure 90: Impact of biosimilars 114

Figure 91: Biosimilar medicine consideration 115

Figure 92: Biosimilars and biologic-treatment stable 116

Figure 93: Biosimilars and cost-effectiveness 117

Figure 94: Biosimilars and sustainability of the PBS 118

Figure 95: Biosimilar medicine recommended by doctor 119

Figure 96: Attitudes to biosimilar medicines – sub group differences 119

Figure 97: Confidence switching 122

Figure 86: Confidence switching – sub group differences 122

Figure 99: Feelings about substitution - detail 123

Figure 100: Feelings about substitution - summary 124

Figure 101: Feelings about substitution – sub group differences 124

Figure 102: Confidence in medicine regulation 126

Figure 103: Confidence in medicine regulation – sub group differences 127

Figure 104: Need to increase understanding of the PBS 127

Figure 105: Specialist overview diagram 131

Figure 106: GP overview diagram 133

Figure 107: Pharmacist overview diagram 135

Figure 108: Consumer overview diagram 137

List of Tables

Table 1: Fieldwork dates 21

Table 2: Response rates 21

Table 3: Sources of awareness of biologic medicines 35

Table 4: Sources of awareness of biosimilar medicines 37

Table 5: Sources of awareness of biologic and biosimilar medicines - comparison 40

Table 6: Potential barriers to prescribing/dispensing biosimilar medicines 46

Table 7: Potential benefits to prescribing/dispensing biosimilar medicines 49

Table 8: Additional comments about biosimilar medicines 82

Table 9: Information the Australian Government Department of Health should communicate to increase understanding of the PBS 86

Table 10: Sources of awareness of biologic medicines 93

Table 11: Sources of awareness of biosimilar medicines 95

Table 12: Sources of awareness of biologic and biosimilar medicines – comparison 98

Table 13: Potential barriers to taking biosimilar medicines 101

Table 14: Potential benefits to taking biosimilar medicines 102

Table 15: Additional comments about biosimilar medicines 127

Table 16: Information the Australian Government Department of Health should communicate to increase understanding of the PBS 130

1 Executive Summary

1.1 Professional stakeholders

Professionals had much higher levels of knowledge of biologic medicines than biosimilar medicines (no doubt due to the relatively recent introduction of the latter into the market). Levels of knowledge of both types of medicine were considerably lower among GPs compared with specialists and pharmacists.

Knowledge of the two types of medicine are highly correlated (in all three professions). Knowledge is also a key driver in confidence in prescribing/dispensing both; and in switching patients from a reference biologic to the biosimilar medicine.

Specialists and pharmacists were significantly more likely to have prescribed/dispensed biologic medicines than biosimilar medicines. However, GPs were equally likely to prescribe both biologic and biosimilar medicines.

Comparison of the results across the two types of medicine, and between the different professions, highlights the fact that levels of prescribing biosimilars among specialists are relatively low (in light of their very high use of biologics). This is likely to be a function of specialists’ concerns about comparability, their reluctance to switch a patient who is stable on a biologic (as described later), and the limited number of biosimilar medicines listed on the PBS.

Sources of biosimilar medicine knowledge varied between groups. Specialists tended to have been informed by academic channels and word of mouth; pharmacists relied more on Continuing Professional Development (CPD) and the National Prescribing Service (NPS); whereas GPs were more likely to have found out about biosimilars online and through media (including social media).

All professional stakeholders were more likely to see potential benefits to prescribing biosimilar medicines than potential barriers. Notably, even stakeholders who saw barriers to prescribing/dispensing biosimilar medicines were nevertheless likely to also see benefits to doing so. Notwithstanding, a considerable proportion of the sample perceived potential barriers.

The relative importance of perceived barriers varied between professions. Specialists and GPs were more likely than pharmacists to raise concerns over patient outcomes. Pharmacists, on the other hand, were twice as likely as the other groups to mention cost-related barriers; particularly the lack of patient incentives. GPs saw the largest barrier as being lack of information, and specifically insufficient information on biosimilar medicines for prescribers.

The most commonly reported perceived benefit was a financial one; with GPs being somewhat less likely to report this than the other two professions. GPs were, on the other hand, more likely to see patient outcomes as an important advantage of biosimilars (notably a relatively small number of specialists mentioned patient outcome benefits).

As well as prioritising the benefits of cost savings, pharmacists were (relative to the other two audiences) comparatively more likely to mention the fact that biosimilars mitigate against medicine shortages.

Pharmacists and specialists tended to be confident in dispensing/prescribing biosimilars; while GPs had the lowest confidence levels.

Importantly, even a minimal amount of information on biosimilar medicine (in the form of a definition presented part-way through the online survey) had an impact on reported confidence levels; particularly among GPs. This suggests that a targeted and informative communication initiative is likely to have significant impact on confidence levels among the research audiences.

Levels of confidence in the comparability between biosimilar medicine and the reference medicine varied. Pharmacists were the most confident in comparability and GPs the least. Familiarity with biosimilar medicine was positively associated with confidence – the more knowledge about biosimilar medicine, the greater the confidence in comparability with the reference medicine.

Despite high levels of confidence and knowledge around biosimilar medicine, specialists (particularly rheumatologists) expressed concerns about substitution, and were reluctant to switch a biologic treatment-stable patient to the biosimilar medicine; this suggests a degree of intractability which is likely to be impervious to a communications initiative. GPs were also reluctant to switch patients who were doing well on biologics; but this tended to be associated with a lack of sufficient knowledge. Pharmacists were much more open to the idea of substitution.

The majority of pharmacists and specialists were confident in counselling a patient about biosimilar medicines. However, only around a half of GPs felt sufficiently confident to do so. This is an important finding, given that GPs were highlighted by consumers as their most important source of information about biosimilar medicine (as described below).

All professional stakeholder audiences raised the need for more information, education and marketing about biosimilar medicines. This highlights the fact that the Department’s forthcoming communication initiative will fill an important and identified information gap, and should, therefore, be well received by stakeholders