Biosimilars are being approved – when should they be on your formulary?

Recent approvals of biosimilars are a critical step toward making biologic therapies – which provide life-saving treatments to patients with chronic conditions – more accessible and affordable for members. As of May 2024, 53 biosimilars have have received approval by the US Food and Drug Administration (FDA).

Recent biosimilar launches, including for the highest utilized specialty medications, are a major milestone in healthcare. At Abarca, we have long advocated for the development and introduction of biosimilars and are thrilled that they are finally coming to market. But now the industry faces a new question: how do we incorporate biosimilars into formularies to provide cost savings while still allowing for optionality?

For many, there is a sense of urgency to immediately incorporate biosimilars into formularies. However, there are a number of important considerations plans must weigh first:

  • Member costs. Not all biosimilars result in out-of-pocket savings for members. For example, manufacturer assistance may cover the member copayments for many specialty drugs. If the biosimilar for a certain therapy doesn’t qualify for the same level of reimbursement, it may make more financial sense to stay on the biologic.
  • Plan savings. Biosimilar manufacturers have taken different strategies in the pricing of their products. Some may have high list prices and high rebates, while others have low list prices relative to the originator brand. Plans need to carefully evaluate whether biosimilars will present cost savings, and which options offer the greatest overall value.
  • Continuity of care. Ensuring that patients can remain adherent to their treatment plans is critical. Any time an alternative therapy is being evaluated – be it a biosimilar or otherwise – the payer needs to determine if any disruptions will occur in the process of switching medications that could result in the member becoming non-adherent, which could result in adverse health outcomes such as disease flares.

In short: There is no one approach to biosimilars that makes sense for every plan. The best options for clients is a customized approach with biosimilar options and originator options provided. That’s why we work closely with each of our clients to determine whether a medication meets their members’ needs and their business and clinical objectives.

And we’re looking forward to continuing to collaborate with our clients to deliver just that as more biosimilars enter the marketplace.

This blog was written by Daniel Reedy, AVP, Drug Value Strategy


Meet Abarca

Why can’t healthcare be awesome? We say it can. And we are making it awesome for millions of consumers across America and the plan sponsors that serve them. Contact us to learn more.

Contact Us