Biosimilars Landscape

Biosimilars: increasing access to quality medications at potentially lower costs. 

Numerous biosimilars are poised to debut in 2023, generating a long overdue increase in competition in the market for the world’s top-selling drugs. As momentum in the biosimilar landscape builds, Pharmacy Benefit Dimensions (PBD) is keeping a finger on the pulse of new product launches and what they mean for our clients and members.

What is a Biosimilar?

Biosimilars
[bio] – biologic (natural) source
[similar] – no clinically meaningful difference  

Biosimilars are medications approved by the U.S. Food and Drug Administration (FDA), deemed therapeutically equivalent to another FDA-approved biologic product, known as a reference product. Biosimilars are subject to rigorous approval standards from the FDA to assure their safety and efficacy. These medications increase treatment options and access to quality medications while also driving cost savings due to heightened competition.

Advancements in the biosimilar market afford PBD the opportunity to increase client and member savings while still providing effective, safe and reliable medications! Our clinical pharmacists are embracing the innovation of the marketplace, seeking and thoroughly reviewing biosimilar options, and continuously making additions and adjustments to our formulary to better serve our members.

Optimizing Value 

Currently, there are no federal or state laws requiring health benefit plans to cover biosimilars. This leaves the power to include or omit these medications in the hands of your Pharmacy Benefit Manager (PBM). At PBD, we are committed to reviewing the placement of biosimilars on our formulary to help contain pharmacy costs for our clients. 

When new biosimilars hit the market, our Pharmacy and Therapeutics (P&T) Committee works to ensure the safety and efficacy of the medication. Our P&T Committee is comprised of independent experts in the medical and pharmacy professions that work in conjunction with our clinical pharmacists to review new and upcoming product launches, government regulations, recalls and other key facets of patient care. This committee meets on a quarterly basis, ensuring timely deliberation in an industry fraught with changing dynamics and escalating costs. Based on these meetings, additions and adjustments are made to the formulary to optimize the value and access we can provide. 

Driving Cost Savings

Our priority is to provide the greatest value at the lowest net cost. The biosimilar landscape is no exception! Remarkably, PBD’s preference of biosimilars over reference products yielded nearly 70% cost savings for our clients and members in 2022. This is a striking value bearing in mind that biosimilar medications are one in the same in terms of safety, purity and potency. 

Specialty Medications: All Eyes on Humira

It’s no secret that specialty medications contribute a staggering amount toward the overall health care spend. Humira, for example, is among the most highly adopted medications on the market. This powerful and essential medication is indicated to treat over 10 conditions such as rheumatoid arthritis, psoriatic arthritis, Crohn's disease, ulcerative colitis, plaque psoriasis and more. However, the price can be incredibly burdensome to self-funded clients as Humira has faced no competition to date. The long-awaited entry of Humira biosimilars this year will finally increase competition, thereby increasing patient accessibility and affordability.  

Given that biosimilars will likely hit the market at a lower price point, it begs the question of how reference products, such as Humira, will respond. With an increase in competition, reference manufacturers may lower prices up front or offer greater rebates in an effort to maintain their market share. Either scenario would generate cost savings for clients and members without any disruption. PBD is committed to monitoring the innovation and evolution of the biosimilar landscape closely, ensuring that we are offering clients and members the medication with the lowest net cost, whether that be the biosimilar or the reference product. While we cannot predict the uptake of biosimilars by prescribers, we can reasonably expect a decrease in pharmacy costs as a matter of course.

“Biosimilars are a win-win; increasing treatment options and decreasing health care spend. For both of those to be true without sacrificing efficacy or safety is something truly exciting and long overdue,” remarks Patrick Comerford Jr., Pharm.D, CDCES, PBD’s Director of Customer Service and Engagement. 

A win-win, indeed! 

It is the responsibility of a quality PBM to seek out more safe and cost-effective treatment options such as biosimilars, especially for members prescribed critical medications with a crippling price tag. As PBD negotiates and contracts directly with manufacturers on behalf of our clients, we are well positioned to pivot as the biosimilar market gains momentum. We are eager and ready to capitalize on this innovation to help reign in pharmacy costs while maintaining access to quality medications.