The progress in biosimilar adoption within the UK has been significant over recent years. Education and clinical experience, alongside regulatory guidance, are among the factors which have provided a framework where these important medicines are now delivering very meaningful levels of savings for the NHS, as well as increased access for patients. But among the achievements, a slew of obstacles continue to thwart biosimilar insulin uptake – which can be overcome with the correct course of action, reveals Warwick Smith, Director General of the British Biosimilars Association, in his latest column.
The UK used to lag behind other European countries in terms of biosimilar adoption, but is now a leading light for biosimilar uptake across the continent.
However, the high levels of adoption we have seen for some biosimilar medicines have not been replicated for all products in all parts of the UK.
One of the reasons behind setting up the Regional Medicines Optimisation Committees by NHS England some 18 months ago was to ensure that best practice is shared throughout the country, and unwarranted variation is removed. Biosimilars have featured prominently on the agendas of these groups in an attempt to ensure that regional differences in usage is minimised.
But as well as geographical differences there are examples where the take-up of specific biosimilar medicines has been much slower than others. This means that the NHS and patients are not able to fully realise the benefits. Biosimilar insulins are one such example of where significant benefits could be released by greater uptake; particularly in view of the number of patients impacted by diabetes and the associated costs of treating them.
Diabetes costs the NHS approximately £10 billion per year and accounts for 10 per cent of the NHS budget. It’s predicted that an ageing population and rising prevalence of obesity will increase NHS spending on diabetes to £16.9 billion by 2035, accounting for 17 per cent of the NHS budget. The use of insulin glargine currently costs the NHS an estimated £82 million per year.
Several biosimilar insulin medicines are already available, and others are expected to be launched in the next few years. However, despite the availability of biosimilar competition, uptake currently stands at around five-to-six per cent. To put this in context, other biosimilar medicines, since their launch, are in the range of 73-to-91 per cent uptake. This indicates a potentially big missed opportunity in terms of NHS savings and thus enhanced access for patients to treatment.
The British Biosimilars Association has examined some of the probable barriers surrounding biosimilar insulin uptake and the main themes can be grouped into three areas which are specific to diabetes when compared with the success in other therapy areas.
First, there is the need for a national policy and guidance from the NHS to ensure that best value for the health service is being delivered in this therapy area and setting out the need to change.
Secondly, more awareness and education are required for prescribers and other specialists involved in the management of diabetes. Compared to other therapy areas using biosimilars, there is a broader group of primary and secondary care healthcare professionals involved in the management of diabetes, which makes education and increasing understanding more challenging. Patients and patient groups also need to be closely involved in this work.
Thirdly, we must not overlook the NHS workforce and capacity issues – for example, with specialist diabetes nurses, who would need to explain the switch to patients, including potentially any differences in how their injection device is used. We believe that any switch decision must always be clinically-led, with the patient involved in the decision. However, better and proactive education to clinicians and patients would support this process and deliver increased uptake in biosimilar insulin and release savings for the NHS.
The differences between the biosimilar insulin market and other disease areas can be positively resolved. There is a role for industry to work collaboratively with NHS England to develop national guidance and processes to support switching, building on the 10 years of successful experience from introducing biosimilar medicines into the NHS.
With the right measures in place, there is no reason why biosimilar uptake of this critical medicine can’t match others. Such is the scale in terms of patient numbers and budget impact, that the opportunities in terms of increasing access and delivering savings for further investment are substantial in the years ahead.
