Biosimilars—biologic medications that are highly similar to drugs already approved by the FDA—are making headlines lately.
There is a growing expectation that biosimilars will transform the specialty drug landscape just like generic drugs did for traditional medications. They can increase access to important therapies and improve patient outcomes, all while providing a lower-cost option for patients.
This is especially significant, as noted in a recent article from Healthcare Brew, because one of the key reasons for patients not picking up their prescriptions is affordability. Providers realize that a critical part of promoting medication adherence is to prescribe a drug they know is affordable for their patients.
Given the importance of drug affordability to keeping patients adherent and healthy, one wonders why the blockbuster drug Humira has managed to maintain 85% market share, even though there are 10 lower-cost biosimilars for the drug.
So why does Humira still control the market? Only one of the Big Three PBMs, CVS’s Caremark, removed Humira from its formulary in favor of biosimilars. As a result, Humira biosimilars went from 5% to 36% of the market following Caremark’s switch in April. Despite Caremark’s move, traditional PBMs haven’t prioritized the lower cost biosimilars because doing so would run counter to their volume- and rebate-driven business models.
As the leading clinically-driven PBM company, EmpiRx Health has been an early adopter of biosimilars. Why? Because biosimilars offer the same level of safety and effectiveness as the original products, but at a lower cost – sometimes substantially lower. And in early 2023, EmpiRx Health was the only PBM that decided to prefer the lower cost Humira biosimilars in its formularies, continuing our practice of biosimilars as the preferred therapy.
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