information needs for pbs - department of health · pdf filesustainability of the...

1 2016 ORC International Proprietary & Confidential

Information needs for PBS Craig Young

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Background & Objectives

Background

Availability of biosimilar medicines in Australia encourages competition, which could, in turn, lower the price government pays for biological medicines and biosimilars.

Lower prices will contribute to the financial sustainability of the Pharmaceutical Benefits Scheme (PBS), provide economic benefits to the wider Australian health care system, and save taxpayers money.

Australian Government has committed $20 million over three years (2015/16-2017/18) to undertake information and education activities to improve the public understanding of biosimilars.

Objectives

The qualitative developmental research objectives of this research were to:

• Assess associated understanding and information requirements around PBS;

• Assess attitudes, knowledge and intentions regarding biosimilars, particularly those on the PBS;

• Inform development of future communication strategies and materials.

Qualitative research is exploratory. It is used to gain an understanding of underlying reasons, opinions, and motivations. It provides insights into the problem or helps to develop ideas or hypotheses for potential quantitative research. Quantitative research generates numerical data.


Methodology

Qualitative research conducted with general public, patients and professional stakeholders (specialists, GPs and pharmacists) • Focus groups used for general public (26

groups) • In-depth interviews used for professional

stakeholders (50 IDIs) Design included regional and urban participants, as well as CALD, Indigenous and “Associated Condition” participants

• Associated Condition focus groups (6 in total) included patients with a range of medical conditions associated with use of biological medicines

• Some (not all) participants were sourced via community support organisations

Amongst the professional stakeholder prescriber audience, there was a deliberate focus on specialists over GPs due to their current role as the prescribers of most biological medicines Fieldwork conducted: March 17 to April 8, 2016. •Stock Photo:Feeding intravenously tool •Image ID:415098010 •Copyright: Babyboom



PBS, PBAC & Generics Objective 1: Assess associated understanding and information requirements around the PBS. (Asked of general public including CALD and Indigenous target groups and those with Associated Conditions only – not professional stakeholders)


PBS, PBAC & Generics

Most aware PBS involved medicines that were subsidised by the government.

There was quite low / no knowledge around how much PBS subsidised medicine represented (in terms of total health budget or medicine by medicine)

Only heavy users/associated

conditions participants said they were aware of

when they got a medicine subsidised through the

PBS.

Most not aware of how medicines get listed on the

PBS.

Once PBAC process was explained, most agreed

that it was a sensible and sound process.

All aware of generics and there was widespread

usage

Most said they were happy to take the generic product, when offered by a pharmacist • highly motivated by the

opportunity to save money by purchasing the generic version


Biological & Biosimilar medicine Objective 2: Assess attitudes, knowledge and intentions regarding biosimilars, particularly those on the Pharmaceutical Benefits Schedule (PBS). (Asked of general public including CALD and Indigenous target groups, those with Associated Conditions and Professional Stakeholders – Specialists, Pharmacists and GPs)


What is it made from? How is it

made?

Because they’re living organisms, there might

be some variability between batches

perhaps, because it would be harder to

control. Is that right?

Where is it made?

Is it made from human material or

blood?

Why is it needed?

What does it do?

Why do you need a biologic why can’t you just use a chemical medicine?

What are the side effects?

If it’s better than chemical

medicines, will all medicines be

biologic one day?

Is it tailored to the

individuals DNA or

something?

It sounds more natural and better for

you than chemicals –

is it organic?

Is it like stem cells?

Is it safe?

Once description of biological medicines was provided (to general public), while most understood the concept that there were chemical and biological medicines, they had many questions…

However the Associated Conditions participants had a good understanding


Awareness

Biological medicines All professional stakeholder groups had good understanding of biologic medicines • with most being very knowledgeable about

them (particularly specialists). Most specialists had prescribed biologic medicines to their patients, and most pharmacists had dispensed biologics to their customers.

Biosimilar medicines Very low awareness of biosimilar medicine among the general public • Participants with ssociated conditions knew a

bit more. Awareness of biosimilars, compared with biologics, was lower amongst all professional stakeholder groups. • While most felt that they knew something/a

little about biosimilars, only some expressed confidence in their knowledge.


Biosimilar medicines – perceived advantages for patients

General Public

Associated Conditions Stakeholders

Expected to be lower out of pocket cost

Would allow for greater treatment choice if they failed on the brand

May result in “less hoops” to jump through

Lower prices of biologic/biosimilar medicines might lead to more other drugs being able to be listed on the PBS which may help me

Raised during market research

Not raised during market research


Biosimilar medicines – perceived advantages for the health system

General Public

Associated Conditions Stakeholders

Lower prices of biosimilars might lead to greater competition and lower prices generally

Save the taxpayer money

Lower prices of biosimilars might contribute to the financial sustainability of the PBS

Lower prices of biologic/biosimilar medicines might lead to more other drugs being able to be listed on the PBS which may help other people with other conditions


Biosimilar medicines - concerns

Participants with associated conditions had different and quite specific questions.

Most general public participants questioned their efficacy, safety and variability.

Professional stakeholders concerns related to establishing their efficacy and understanding issues of variability, particularly in relation to the impact of switching on patient outcomes.


Biosimilar medicines - intentions to use & substitution

General public was happy to use biosimilars in the future. They trusted the views of the professionals/specialists and believed that they would only prescribe a drug which was proven effective.

Associated condition patients on biologics were also not overly concerned about being prescribed an original brand versus a biosimilar, as they were largely comfortable in terms of efficacy and safety – so long as it was a new prescription, or if efficacy on the reference brand had waned. • They were very concerned about the prospect of being switched to the biosimilar if the

original brand was still effective. Caveat: Once participants realised that there would not be a difference in their own “hip pocket”, on balance some said that given the choice they thought they would opt for the original brand over the biosimilar. Importantly, most said they would not accept an alternative brand of their biological medicine if they were offered it by their pharmacist • without having first discussed it with their specialist

(and particularly if it was not significantly cheaper for them personally)


Biosimilar medicines - intentions to prescribe/dispense

Professional stakeholders identified similar barriers (to those raised when asked to identify potential concerns) when asked if they would prescribe/dispense biosimilars, i.e.:

• Effectiveness • Impact on patient outcomes • Switching • Being proven.

A further barrier – at least for some stakeholders – is lack of knowledge/ understanding/awareness of biosimilars. Most common reasons for being willing to substitute included patient affordability, saving taxpayer money and the sustainability of the PBS. Main reason unwilling to substitute a biological with a biosimilar was the potential impact on patient outcomes

• (again – particularly for current patients having success on their current medicine)


Communications barriers, strategies & potential actions Objective 3: Inform the development of future communication strategies and materials. (Asked of general public including CALD and Indigenous target groups, those with Associated Conditions and Professional Stakeholders – Specialists, Pharmacists and GPs)


Potential barriers to government raising awareness and increasing usage of biosimilars

Most general public not aware of biological medicines whereas most professional stakeholders had a good understanding (of biologics, less so for biosimilars) • Low awareness among general public because few

people use them.

Those who are healthier tend to know less than those with an existing condition • So in terms of communications strategy the

department is likely to get better bang for buck by targeting patients rather than the general community.

Concerns related to switching medicines a barrier to use of biosimilars, and specialists more likely to recommend biosimilar to new patients than existing patients due to lack of confidence • However, information about successful switching

could help - as could information around how a fail is treated.

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About half of specialists answered ‘No’ when asked: ‘Does government have role to play in informing the general public about Biosimilars?’ • This lower support for patient targeted

government communication could present some barriers when rolling out an awareness initiative (in that for example some specialists may not pass on a brochure or fact sheet).

• However, we expect that many patients (and particularly those with chronic conditions) will do their own research and will ultimately be able to source information via other channels (such as online or via community support organisations).

• Specialists may be willing for the government to provide information to them to give to their patients.

Currently there is a lack of financial incentive for people to switch • Communications will need to explain that we need

a sustainable system so that other drugs can be listed etc. Image ID:416804305

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Those not heavy users of medicines are typically not knowledgeable about the PBS • There certainly appears to be a need to increase

the visibility of the PBS as a significant component of the health system, particularly as sustainability of the PBS is a motivator for the move to biosimilars.

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Where to from here – potential actions

Specialists are key to prescribing biosimilars and encouraging patients to make the switch • Specific targeting of communications to

specialists – particularly related to successful switching of patients - is likely to be important to encourage further uptake of biosimilars.

Despite acknowledged importance of the role of specialists, most participants felt that there was a need for the Government to provide simple information, available in plain English about the different types of medicines available in Australia (including biosimilars) and the role of the PBS.

This way, should they ever need to know more about biological medicines and biosimilars, they would be able to find information from a trusted source • As government seen as a credible

source of independent information.



Key messages regarding benefits of using biosimilars for patients and the health system should be related to the perceived advantages identified. • And could be delivered via a simple/short

brochure (that could be made available via specialists, GP offices, hospitals, AMS clinics and pharmacies either hard copy or printable on demand).

There were also expectations Government could provide: • Information on its website which would be

simple for someone to find, including the simple brochure and a more complex/detailed Q&A style fact sheet.

• Information to support groups and the community organisations to distribute to members (via email or posts on forums)

• Press releases to the media. • Some suggested that it would be useful to

have a video online explaining the different types of medicines.



All professional stakeholders are interested in receiving more information about biosimilars.

Most effective communication channels for these stakeholders: • National Prescribing Service (NPS) and the

associated NPS Radar email alerts. • Specialty associations (i.e. Australian

College of..., AMA, etc.), and typically broadcast emails from the Secretary and participation/presence at seminars/conferences.

• Articles in medical journals. • Having information online on the

department’s website.

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