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4 key barriers holding biosimilars back (and how to remove them)

Complex formulary structures, high initial pricing, entrenched market advantages favoring established brands, and hesitancy among prescribers and patients have slowed adoption, leaving billions in savings untapped.

By Mark Campbell | December 17, 2024 at 09:00 AM

Spending on prescription drugs rose 9.9% in 2023 alone, while pharmacy benefits remained the fastest growing component of health care in 2024. With prescription benefits costs expected to continue rising – estimated to increase more than 8% next year – solutions that can lower costs for patients and plan sponsors are needed more than ever.

An estimated 45% of plan members today use biologics and biosimilars – more affordable, clinically comparable versions of these high-cost drugs that are no longer protected by patents. This shift offers a promising way to reduce costs and expand access to essential treatments. As of February, there are 10 available biosimilars to Humira, a blockbuster drug launched in 2002. More recently, the U.S. Food and Drug Administration approved the sixth biosimilar to Stelara, which is second only to Humira in sales. Presumably this should have led to rapid transition to the lower-cost options and savings for patients and plan sponsors.

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