Barriers to Biosimilar Prescribing Incentives in the Context of Clinical Governance in Spain

Abstract

Incentives contribute to the proper functioning of the broader contracts that regulate the relationships between health systems and professionals. Likewise, incentives are an important element of clinical governance understood as health services’ management at the micro-level, aimed at achieving better health outcomes for patients. In Spain, monetary and non-monetary incentives are sometimes used in the health services, but not as frequently as in other countries. There are already several examples in European countries of initiatives searching the promotion of biosimilars through different sorts of incentives, but not in Spain. Hence, this paper is aimed at identifying the barriers that incentives to prescribe biosimilars might encounter in Spain, with particular interest in incentives in the framework of clinical governance. Both questions are intertwined. Barriers are presented from two perspectives. Firstly, based on the nature of the barrier: (i) the payment system for health professionals, (ii) budget rigidity and excessive bureaucracy, (iii) little autonomy in the management of human resources (iv) lack of clinical integration, (v) absence of a legal framework for clinical governance, and (vi) other governance-related barriers. The second perspective is based on the stakeholders involved: (i) gaps in knowledge among physicians, (ii) misinformation and distrust among patients, (iii) trade unions opposition to productivity-related payments, (iv) lack of a clear position by professional associations, and (v) misalignment of the goals pursued by some healthcare professionals and the goals of the public system. Finally, the authors advance several recommendations to overcome these barriers at the national level.

Perceptions About Biosimilar Medicines Among Belgian Patients in the Ambulatory Care

“…Each country within the European Union (EU) has its own healthcare system. Therefore, countries with low biosimilar uptake have their own specific reasons for this ( Ingrasciotta et al, 2015 ; Remuzat et al, 2017 ; Moorkens et al, 2019 , 2020a ; Lobo and Río-Álvarez, 2021 ; Van Wilder, 2021 ). However, general elements seem to be the lack of prescribers’ incentives, limited guidance and position of regulatory authorities about transitioning to biosimilars, the innovator’s reach, and the limited understanding of biosimilars among healthcare providers (HCP) and patients ( Moorkens et al, 2016 ; Remuzat et al, 2017 ).…”

Patient-Reported Outcomes in Rheumatoid Arthritis: A Key Consideration for Evaluating Biosimilar Uptake?

“…A significant barrier to the uptake of biosimilar medicines is misinformation and mistrust from patients and health-care professionals. 32 Patients’ preferences regarding switching remain important but are often not considered fully. The available data indicate that some RA patients may be more susceptible to nocebo effects, especially in patients with non-medical switching, suggesting that knowledge of a switch to a biosimilar product may have affected treatment efficacy.…”

“…Shared decision-making processes between RA patients and their clinicians are associated with good disease response, increased biosimilars’ acceptance, and reducing the nocebo effect. 32 , 39 , 75 , 80 …”

“… 6 , 7 The lower price of biosimilars may allow more patients to be treated earlier in their disease course. 1 , 6 , 11 , 32 Biosimilars are increasingly used in routine care of patients with RA. 33 However, the uptake of biosimilars has varied considerably between countries.…”

Assessing Knowledge and Attitude of Healthcare Professionals on Biosimilars: A National Survey for Pharmacists and Physicians in Taiwan

“…European researchers concluded that physicians informed through official and reliable sources tend to view biosimilars positively and are more willing to improve their knowledge about biosimilars. Likewise, those who partook in a shared savings system with better-aligned reimbursements were more likely to adopt biosimilars and change their prescription patterns [28]. Hence, recognizing their effort through incentives and other forms of shared benefits encourages long-term commitments.…”