Since some Humira biosimilars will be available without a rebate, it will be possible to buy more efficiently outside of a rebate contract. The savings arguments that PBMs have touted for years are untrue and today PBMs are providing deeper rebates while claiming nothing has really changed. To perpetuate the rebate game, it's imperative for PBMs to control biosimilar access the exact same way as Humira, through rebates. This means inflating prices and limiting access will continue. Humira's manufacturer, AbbVie, who has more to lose than the Big 3 PBMs, is offering even higher rebates to keep the rebate façade alive. This is how it will likely play out:

PBMs will continue to encourage doctors to keep patients on Humira as long as possible, even when lower-cost, or more effective, therapies are available.
To be included in formularies, biosimilar manufacturers will be forced to offer rebates, locking out biosimilar competition, inflating prices, and improving PBM profits.
PBMs will make more money as rebates increase; therefore, they won't encourage lower prices or switching to lower cost drugs.
PBMs are opposed to drug switching, and along with AbbVie, are incentivizing use of AbbVie's successor therapies, Skyrizi and Rinvoq, so the game will remain alive for another drug generation.
Employers who could have just said, 'no', will continue to pay more.

New year, same fake competition

If biosimilars don't achieve expected adoption rates, it's not because they didn't deliver; it's because the only world in which they can make a difference is one where real competition exists. In a free market, consumers would pay the lowest price for things that work and biosimilars would be a staggering success, just like generic drugs. Instead, we will continue to pay more for less.

Instant Insights /

Why biosimilars will fail: and what we can do about it

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