Background/Purpose: There is interest in employing biosimilar therapies for patients with rheumatoid arthritis (RA), which have been shown comparable to originator biologics in safety and efficacy but lower in cost; another strategy is “white bagging” where rheumatologist administered drugs are sent by a specialty pharmacy to the rheumatologist’s office.To date, four infliximab biosimilars are available and various payors have implemented white bagging programs. We assessed what drives rheumatologists to prescribe an infliximab biosimilar and participate in white bagging drug programs.

Methods: We conducted an online cross-sectional survey of hospital and community-based rheumatologists in July 2019 and June 2020. Questions assessed willingness to prescribe biosimilars, the quality, safety and effectiveness of biosimilars compared to originator biologics, what influences a rheumatologist’s decision to prescribe a biosimilar and reasons rheumatologists would not switch from buy-and-bill to white-bagging. We used a Likert scale rating of “Never,” “Seldom,” “Sometimes,” “Often” and “Always.” Descriptive statistics and percentages are reported (n=43).

Results: Rheumatologists reported prescribing an originator biologic drug often or always 58% of the time. When asked to what degree a biosimilar matches the originator biologic in terms of safety, effectiveness and quality, rheumatologists reported the biosimilar as being the same 77%, 74% and 72% of the time, respectively. In spite of this, when asked to report their expected likelihood of prescribing a biosimilar in the future, only 35% of rheumatologists believed they would often or always prescribe a biosimilar. Provided financial equivalence, rheumatologists reported being more likely to prescribe a biosimilar 65% of the time to new patients and 47% of the time to existing patients. The top 3 reasons for prescribing a biosimilar are the patient’s out of pocket cost, cost to the practice and the value of reimbursement, 72%, 67% and 56%, respectively in fee-for-service reimbursement arrangements and 72%, 63% and 51%, respectively, in value-based reimbursement arrangements. When asked why rheumatologists would not switch from buy-and-bill to white-bagging, financial benefit to the rheumatologists’ practice (63%) and control of the drug (58%) were the top 2 reasons.

Conclusion: The majority of rheumatologists in this study reported currently prescribing originator biologics most of the time at their practice. The rheumatologists also perceived biosimilars to be as safe and effective as the originator biologic. Additionally, the surveyed rheumatologists expressed a willingness to prescribe biosimilars in the future, provided income would not be reduced. RA is associated with considerable economic burden; lower-cost biosimilars may provide an opportunity to reduce overall patient and health system costs; white bagging programs are not supported by rheumatologists due to revenue loss and chain of control concerns. Supporting provider income in any cost reduction program is key to program success.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatologists-perception-of-the-efficacy-safety-and-willingness-to-prescribe-infliximab-and-use-alternate-drug-supply-programs-to-lower-cost-of-rheumatoid-arthritis-care/