Promise to Proof – Biosimilar Access Wins and Savings
If you’re part of or following the pharmacy benefit management (PBM) industry, you’ve likely been hearing the term “biosimilars” more and more frequently. But what are biosimilars, how are they different from brand name drugs (reference products), and why are some PBMs so excited to add them to formulary while other PBMs try to avoid them?
The U.S. Food and Drug Administration (FDA) defines biosimilars as “safe and effective biologic medications that are highly similar to biologic medications already approved by the FDA (reference products).”1 That means there aren’t any significant differences when it comes to their safety and effectiveness compared to the brand name reference products. You might also hear them referred to as interchangeable biosimilars, which simply means that they can be substituted for prescribed drugs at the pharmacy, similar to how generics are often given in place of brand name drugs.
The Truth About Biosimilars
As biosimilars are relatively new to the market, there can be many misconceptions about what they do and don’t do, so we’ll clear those up using the chart below.
Myth |
Fact |
|---|---|
|
Brand name drugs are better because their biosimilars aren’t as safe or effective |
Biosimilars are just as safe and effective as the brand name drug |
|
Biosimilars cost less because they’re less effective |
Biosimilars cost less because they’re not starting from scratch |
|
Biosimilars are too new to be fully safe or trusted |
Biosimilars come to market faster because they’re based on drugs that are already available |
The Cure for High-priced Medications
Humira is the highest-grossing medication of all time, with approximately $200 billion in revenue for AbbVie since launch.2 But in 2023, Humira biosimilars hit the market. Navitus, seeing the value of biosimilars to payers and their members, was able to convert 97% of prescriptions from Humira to biosimilars, creating an estimated upfront cost savings of $315 million and leading to a 5% drop in net costs in the targeted immunomodulators (TIMs) category for commercial plan sponsors. Keep in mind, that’s savings for just one medication.
At its height, before biosimilars were available in 2022, Humira was nearly $10 PMPM in our book of business with a fairly hefty rebate of about $4 PMPM, so a pretty good amount. Once the first biosimilar launched in the beginning of 2023, we saw a rebate bump which helps push costs down… once multiple biosimilars came out, we saw a significant decrease due to enhanced rebates with the originator brand Humira in the second half of 2023. These savings alone pushed the whole TIMs category down in terms of cost.
Ryan Schmidt, PharmD, Navitus Associate Director of Business Insights
If we look at the industry as a whole, the use of biosimilars added up to about $20 billion in savings in 2024 alone. And with emerging coverage at the federal level for some biosimilars under Medicare Part D, that number will continue to rise. Since their introduction in 2015, total savings due to biosimilars are now over $56 billion, according to the Association for Accessible Medicines (AAM).3
Current Action Means Future Savings
Learning from the first big breakthrough around Humira, many manufacturers and PBMs alike are moving faster as more biosimilars are created and added to formularies. Stelara, a drug with a wholesale acquisition cost (WAC) of nearly $30,000, saw no less than 10 biosimilars come to market in the last few years, driving competition up and prices down, anywhere from 40-90% off the price of the brand name drug. At the same time, the evolving FDA interchangeability guidance has been lowering development hurdles, allowing more biosimilars to come to market faster. For 2026 and beyond, these waves of biosimilar options will continue to save money for health plans and payers, but only if they’re working with PBMs aligned with their best interests.
While transparent, pass-through PBMs like Navitus seek out biosimilars to lower trend year-over-year and offer the best value, traditional PBMs may not be so quick to adopt biosimilars. Why? In a word: rebates. Traditional PBMs often rely on spread pricing and rebate retention, which creates hidden costs for plan sponsors and members. The larger the spread between drug cost and rebate savings, the more money they can make. So they may stick with the brand name drug instead of adopting less-expensive biosimilars.
If you think biosimilar adoption is a future worth embracing, reach out to [email protected].
We’ll be covering even more updates on the state of our industry in the upcoming 2025 Navitus Drug Trend Report.
References
1. U.S. Food and Drug Administration. 9 Things to Know About Biosimilars and Interchangeable Biosimilars. Updated June 20, 2024. Accessed March 10, 2026. 9 Things to Know About Biosimilars and Interchangeable Biosimilars | FDA
2. Wainer D. What a $200 Billion Blockbuster Drug Reveals About Big Pharma’s Playbook. Wall Street Journal. What a $200 Billion Blockbuster Drug Reveals About Big Pharma’s Playbook – WSJ
3. 2025 U.S. Generic & Biosimilar Medicines Savings Report. Updated September 3, 2025. Accessed March 10, 2026. https://accessiblemeds.org/resources/reports/2025-savings-report/
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