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Switching, on the other hand, is a decision by the physician to exchange one medicine for another with the same therapeutic intent in a given patient. Alternation also refers to switching.³³ Another term in this context is non‐medical switching (NMS) referring to when a patient whose current therapy is effective and well‐tolerated is switched between therapies, such as an innovator biologic to its biosimilar for an economical, formulary, or other nonmedical reasons, i.e. for reasons other than the patient's health and safety.³⁴ Generally, NMS may be initiated by a hospital pharmacist, based on the local formulary, or the insurance company providing health insurance in consultation with the patient and the physician. The Biologics Prescribers Collaborative (BPC), representing specialist/general physician prescribers, and Alliance for Patient Access (AfPA) have developed NMS principles and guidelines.³⁵

Shared decision‐making between physicians, pharmacists, and patients is crucial for successful switching.³⁶ Patients' attitudes and level of satisfaction with switching to a biosimilar is related to being provided with necessary information about their health.³⁷ A comprehensive review concluded that evidence gaps around efficacy and safety of switching still exist.³⁸