Nationwide Switch to Adalimumab Biosimilar Led to Greater Workload, Decreased Satisfaction


This is the first research to allow for greater insight into the impacts on providers of a nationwide change to an adalimumab biosimilar.

A nationwide brand change to an adalimumab biosimilar may lead to health care providers having greater workloads and diminished satisfaction levels, according to new findings, with experiences seeing potential improvement if training, patient support, and other key elements are implemented alongside the switch.1

These results were observed in a recent study in New Zealand, conducted in order to assess the results of a potential transition of patients to biosimilars to reduce costs and generally improve access to care.2 The investigators sought to look at impacts on health care providers who would be at the frontlines of such changes.

This new research into the nationwide change was led by Chiara Gasteiger, PhD, from the University of Auckland in New Zealand.

“This study examines providers’ satisfaction with the process of transitioning patients to an adalimumab biosimilar,” Gasteiger and colleagues wrote. “Provider satisfaction with the supply of the biosimilar and logistics of the transition, administrative burdens, information and education, and availability of support are explored.”

Background and Findings

The investigators’ research involved the use of a cross-sectional online survey design, and it was conducted among practicing healthcare professionals such as rheumatologists, pharmacists, and nurses that specialized in rheumatology. The team’s collection of data took place from November 2022 - February 2023.

These health care providers were in Aotearoa New Zealand in the period of a biosimilar transition from March - September 2022. All of the providers were believed to be proficient in the English language and to have the capability to finish the team’s online survey online.

The survey questions were formulated utilizing the input of a patient research partner who had reported having firsthand experience with the transition and was undergoing adalimumab treatment of ankylosing spondylitis. A team collaborated on this survey, made up of a rheumatologist, a pharmacist, a rheumatology specialist nurse,and a health psychology researcher.

The analysis was promoted by several key organizations which comprised the New Zealand Rheumatology Health Professionals Association, New Zealand Rheumatology Association, and Pharmaceutical Society of New Zealand. Study subjects that were interested accessed the participant information sheet, responded to the eligibility inquiries, and gave their informed consent.

Those participating filled out a concise, 10-minute survey online which was used to look into their demographic data and their level of satisfaction related to the new transition in 4 major areas:

  • Education and communication
  • Logistics and supply
  • The availability of support
  • Administrative aspects

The study’s investigators utilized open-ended questions to gauge the overall effects of the switch on the subjects’ workloads and to elicit feedback regarding the elements of the transition that were shown to be successful and less successful.

Overall, the research team reported that the switch to the biosimilar, as evaluated by a mean satisfaction score from a scale of 0-10, led to an average rating of about 5.7, with a standard deviation of 2.6. The team found that providers reported the lowest levels of satisfaction with training that involved the biosimilar device, with the information provided from government agencies, and with the administrative work necessary at the time of the transition.

Furthermore, the investigators concluded that levels of provider satisfaction were shown to have decreased for elements such as the biosimilar’s safety, its efficacy, the quality of the device, and the availability of alcohol wipes, sharps bins,and support for patients following the change.

The research team also noted that provider satisfaction with the newly-required administrative workload and training for the device were shown to be predictors of their overall satisfaction. Health care providers noted specific issues they had in the transition process, and these included a poorly-implemented initial authorization process, the lack of a patient support program, and an insufficient level of communication between providers.

That said, the investigators did note that the citrate-free preservative and the longer authorization duration which had followed the switch were shown to be well-received by health care providers.

“Despite differences in roles and responsibilities between rheumatologists, pharmacists, and rheumatology nurse specialists, the findings demonstrate the importance of ensuring the biosimilar brand package is comparable with the originator and that the administrative and educational process is simple for all health care providers involved,” they concluded.


  1. Gasteiger C, Lobo M, Wong LS, Murdoch R, Dalbeth N. Health Care Providers' Experiences of a Mandatory Nationwide Transition to an Adalimumab Biosimilar [published online ahead of print, 2023 Oct 1]. ACR Open Rheumatol. 2023;10.1002/acr2.11617. doi:10.1002/acr2.11617.
  2. Pharmaceutical Management Agency. Decision to widen access to adalimumab and award principal supply. URL:
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