Oncologists’ Common Misconceptions About Biosimilars Revealed in a Recent Survey

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Although there is some progress in the adoption of biosimilars in the United States, oncologists’ knowledge regarding these agents has not kept pace with the introduction of new biosimilars into the US marketplace, especially in oncology, suggested John Devin Peipert, PhD, Assistant Professor, Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, at the 2021 ASCO Quality Care Symposium.

Dr Peipert presented findings from a late-2020 survey of clinical oncologists who responded to questions regarding their overall knowledge and perspectives of biosimilars and their prescribing practices.

Dr Peipert and colleagues conducted a large-scale survey of oncologists using the ASCO Survey Research Pool to examine oncologists’ knowledge, attitudes, and experience with biosimilars. The survey identified major knowledge deficits among oncologists about the basic features of biosimilars.1

Biosimilars are sold at a reduced cost relative to the reference drug. Despite the potential of biosimilars to reduce healthcare costs significantly, however, the uptake of their use in the United States has been slower than expected, said Dr Peipert, which may derive from oncologists’ hesitancy about these drugs.

“Approximately half of the oncologists surveyed did not realize that biosimilars were not the same as generic medications,” said Dr Peipert. “That might be a technical point, but we found it remarkable that something so basic would not be known by all oncologists.”

As all clinicians should know by now, biosimilars are not the same as generic drugs; rather, a biosimilar is a biologic drug that is highly similar to an existing, FDA-approved reference biologic drug, with no clinically meaningful differences in safety and efficacy.

“After speaking to several providers, we learned that biosimilar adoption is not really a patient-level decision point,” said Dr Peipert. “It comes down to the physicians, specifically their ability and willingness to prescribe. Sometimes they have that freedom; sometimes they don’t.”

A total of 269 clinical oncologists responded to a 29-question survey between October 6, 2020, and November 16, 2020. The survey was designed with structured input from clinical and healthcare system experts and literature review.

Of the 269 respondents, 88% of the oncologists have been treating patients with biosimilars and reported that biosimilars were required at their institution. Nevertheless, approximately 50% of the respondents indicated (incorrectly) that biosimilars are the same as generic drugs.

“Although a majority of oncologists reported treating with biosimilars, their knowledge of biosimilars was limited,” said Dr Peipert.

The responding oncologists also revealed a lack of knowledge about interchangeable biosimilars, which are biosimilars that may be replaced by the pharmacy instead of the reference drug without consulting the prescriber.

To date, only 2 biosimilars have been approved by the FDA as interchangeable; the first was insulin glargine-yfgn, which was approved as an interchangeable biosimilar with its reference drug, Lantus, in July 2021, and the second was adalimumab-adbm, which was approved as an interchangeable biosimilar with Humira in October 2021.

Furthermore, the survey highlights that oncologists in the community and in private practice settings were more concerned about the safety and efficacy of biosimilars than oncologists practicing in academic settings.

A total of 38% of oncologists in the community and 38% in private practice settings reported that concerns with efficacy have been a barrier to their prescribing of biosimilars; in addition, 30% and 29% of respondents, respectively, noted concerns about the safety of biosimilars. By contrast, oncologists in academic hospitals were far less likely to have such concerns.

“Oncologists are aware of biosimilars, but they don’t seem to know a ton about them,” said Dr Peipert. “That lack of knowledge may cause hesitancy to prescribe these drugs in some cases, even though they are coming on the market with equivalent efficacy and safety.”

“Clearly, there is a great deal of opportunity for new educational interventions or quality improvement programs for oncologists,” Dr Peipert said.

The gap between the supply and demand for education suggests a need for new biosimilar quality improvement and educational programs in the United States, he noted. These programs should build curricula to address key knowledge gaps and misperceptions about biosimilars among oncologists.

“As more and more biosimilars are approved and show up in formularies, oncologists will become increasingly interested in consuming educational resources that are available,” he said. “There is a huge opportunity for new educational interventions or quality improvement programs for oncologists, but we should determine the optimal way to deliver that information first.”

Dr Peipert suggested that such educational resources should consist of easy-to-consume comparisons between biosimilars and generic drugs, along with statements about interchangeable drugs and bulleted reviews of the evidence regarding the safety and efficacy of biosimilars.

“These resources wouldn’t have to be too intensive, because some of the lack of knowledge was about very basic elements,” he concluded.


  1. Peipert J, Kaiser K, Kircher SM, et al. Oncologists’ knowledge and perspectives on the use of biosimilars. J Clin Oncol. 2021;39(28_suppl):35.
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