Information needs for PBS
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
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
Once PBAC process was explained, most agreed that it was a sensible and sound process.
All aware of generics and there was widespread usage
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.
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)
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)
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 associated 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
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
Associated
Conditions
Stakeholders
Biosimilar medicines – perceived advantages for the health system
General
Public
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
Associated
Conditions
Stakeholders
Biosimilar medicines – concerns
Most general public participants questioned their efficacy, safety and variability
Participants with associated conditions had different and quite specific questions.
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.
Potential barriers to government raising awareness and increasing
usage of biosimilars
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.
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.
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.
Where to from here – potential actions
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.