Determinants of prescribing decisions for off-patent biological medicines in Belgium: a qualitative study

Abstract

Background A competitive market for off-patent biologicals leads to more affordable and high-quality healthcare. In recent years, Belgium has been characterized by its low use of biosimilars and by its shifts from off-patent biologicals toward new alternative therapies. Yet, the prescribing decisions involved in these observations are poorly understood. This study aims to better understand prescribing choices among Belgian physicians in the ambulatory care setting. Methods This study consisted of two phases. First, a scoping literature review to identify determinants of prescribing choices was conducted. Scientific databases (Embase and PubMed) were searched until 4 November 2021. Second, the nominal group technique (NGT) was employed during focus group discussions with Belgian physicians to consider and validate these determinants for off-patent biologicals in the Belgian context. The qualitative data resulting from the literature review and focus group discussions were analyzed using the thematic framework method. Results Fifty-three scientific articles that discussed elements that determine prescribing choices were identified. Out of these, 17 determinants of prescribing choices were found. These were divided into five categories: (1) product-related, (2) physicians’ personal, (3) healthcare system-related, (4) patient-related, and (5) determinants related to the pharmaceutical company or brand. Nineteen Belgian physicians from different therapeutic areas that regularly prescribe biologicals then participated in focus group discussions. Using the NGT, the group discussions revealed that prescribing choices for off-patent biologicals are determined by a complex set of elements. Clinical data, geographical region, working environment, pharmaceutical marketing, patient profile, clinical guidelines, and preference of key opinion leaders (KOL) were considered most influential. Physicians indicated that the importance of these determinants differs depending on product classes or therapeutic domain. Conclusions Multiple elements determine the choice of an off-patent biological or biosimilar product. The importance of each of these determinants varies depending on the context in which the prescribing choice is made. To increase the prescription of best-value biologicals in the Belgian ambulatory care, a set of synergistic measures is required including information for healthcare providers (HCP) and patients, prescribing feedback, prescribing targets, tangible incentives, KOL involvement, guidelines regarding pharmaceutical promotion, and regular revision of reimbursement modalities.

The Influence of Pharmaceutical Companies Marketing Activities on Physicians’ Prescribing: Literature Review

“…This strategy is used to influence the physicians' prescribing behavior. The strategies used by various pharmaceutical companies around the world such as Jordania 12 , the United States 13 , Ethiopia 14 , Lebanon 15 , India 16,17 , Australia 18 , and Belgium 19 . Mix marketing strategy is the most strategy used by pharmaceutical companies.…”

Evaluating the benefits of TNF-alfa inhibitor biosimilar competition on off-patent and on-patent drug markets: A Southern European analysis

“…In this line, our analysis indicated that shifts in drugs utilization towards on-patent immunomodulators occurred after loss of exclusivities for TNF-alfa inhibitors, notwithstanding higher acquisition costs. As indicated by Vandenplas et al, there can be multiple determinants of prescribing decisions (Vandenplas et al, 2022). Shifts in prescribing from off-patent TNF-alfa inhibitors towards higher-cost second and third generation on-patent products could be partly due to the greater availability of dedicated physician education and patient support programs for these products.…”

Launching a new brand in the multi-brand portfolio: real world observational study evaluating mediating role of detailing priority and detailing time on physicians’ prescription behavior

“…For new products, physicians require substantial information about the efficacy and safety profile of the drug, various clinical trials done for the molecule, the approvals given by the relevant authorities and additional benefits as compared to established brands (Mizik and Jacobson, 2004;Narayanan and Manchanda, 2009;Faisal et al, 2020;Morgan and Zane, 2022). Since PSRs are the ones who introduce new products to physicians, the onus of explaining newly launched products and providing required information for reducing uncertainty about newly launched drugs lies with PSR (Narayanan and Manchanda, 2009;Alkhateeb et al, 2011;Faisal et al, 2020;Vandenplas et al, 2022). Avorn et al, 1982 have observed that scientific information is a major source of influence on physician's prescription behaviour, more so for new drugs (McGettigan et al, 2001;Narayanan and Manchanda, 2009;Faisal et al, 2020) as compared to established brands.…”

“…Pharmaceutical companies, while meeting the health needs of the consumers, also strive to generate profits for research, development and sustenance (Ion et al , 2021). Hence, pharmaceutical companies play a crucial role in enabling physicians to make informed choices (Levy, 1994; Menebo, 2021; Vandenplas et al , 2022) and cater to patient needs effectively.…”

“…Detailing new brands is informative in nature since physicians need more scientific information about the drug, whereas detailing established brands is persuasive in nature as physicians have already learned well about the brands (Ackerberg, 2001; Narayanan and Manchanda, 2009; Ching and Ishihara, 2012; Huang et al , 2019; Rhee and Yi, 2022). Secondly, detailing has a significant effect on physician’s prescription behaviour (Narayanan and Manchanda, 2009; Dambrin and Robson, 2011; Menebo, 2021; Morgan and Zane, 2022; Rhee and Yi, 2022; Al Thabbah et al , 2022; Vandenplas et al , 2022). Thirdly, physicians’ response to detailing is heterogeneous in nature.…”