As health care costs continue to soar, biosimilars offer a welcome reprieve.
While biological drugs, or biologics, are medications developed from living organisms, biosimilars present an alternative that is nearly (but not quite) identical. These drugs are designed to deliver the same therapeutic effects as their biologically derived counterpoints, much like a generic alternative to a brand-name.
Common biologics include vaccines, gene therapies and long-acting insulin. But these critical medications tend to be painfully expensive.
Comparing Costs: Biologics Vs. Biosimilars
The top 3 most expensive brand name drugs are biologics.
And, like other health care costs, the price of biologics continues to rise. The list price for HUMIRA® – the most expensive drug for most health care plans – has increased by 138%. Luckily, a few HUMIRA biosimilars are currently available and more are in development this year.
While biologics tend to be cost-prohibitive, biosimilars cost an average of 50% less, according to a report from the Association for Accessible Medicines.
Switching from a patented specialty drug to a biosimilar alternative can save between $1,000 and $4,000 per prescription fill. Those savings can stack up and potentially offset other rising expenses.
To date, biosimilars have saved $26.3 billion in direct health care costs since they were introduced in 2015.
Of course, the cost savings are nice, but the lower price of biosimilars also means that more patients are able to afford the medications they need.
Biosimilar Barriers at the Pharmacy
Even though biosimilars typically cost less, not everyone is using them. For one, prescribers and patients don’t always know to ask for them. When they are prescribed, patients can face barriers at the pharmacy.
Pharmacy benefit plans have a huge impact on usage and availability. If pharmacy benefit managers have already contracted for the more expensive reference product, they don’t have any incentive to cover a lower cost alternative.
That can run up huge health care bills for individuals and businesses.
With Custom Design Benefits, you can be sure we’ve examined pharmacy benefit options to find the lowest net cost options. For questions about biosimilar coverage, reach out to your Account Manager.