Health care leaders and PBMs should pay special attention to what happens next. The potential of biosimilars to improve outcomes and lower costs is a powerful combination. PBMs can use clinical and analytical data around both to determine which drugs to include on their formularies. And while rebate programs have been an incentive to PBMs in drug selection, efficacy and cost can be explored in tandem.
Drugs that show efficacy in improving outcomes while lowering costs are always top of mind. A good example is the drug Humira, which is most commonly prescribed for certain types of arthritis. Humira has a total global revenue of $20 billion (paywall) and typically costs $5,800 for a supply of two kits. The FDA has approved six biosimilars for Humira, the most recent approval being Hulio earlier this year.
PBMs play a crucial role in helping patients and prescribers determine the highest quality, lowest cost and most effective and safe biosimilars. Since biosimilars are lower in cost naturally, biosimilar manufacturers won’t need to set pricing high, and there won’t be the need for extensive rebate programs to make options more affordable to clients. Skeptics have long since pushed for better transparency around PBM rebates, but big manufacturers will no longer be able to use this as a scapegoat for rising drug prices.
One challenge PBMs and health care companies may face as they work to increase biosimilar adoption is health literacy. I’ve observed that part of the slow adoption of biosimilars is the general knowledge gap among health-care provides and patients alike about biosimilars. These companies can use their platforms and credibility to help educate through health-care provider and patient education programs. While fear of biosimilar’s newness may make some partners skittish about putting their own brand equity behind them, biosimilars have gone through the same process that any other drug approved by the FDA has gone through. Therefore, this validation must be part of awareness efforts messaging.
It is possible to transform the drug market to one that is a high outcome and lower cost, however, I believe all players must be willing to consider new approaches to the model. We must be driven by the potential of innovation and science. Biosimilars could change the business model of drug pricing. With affordable options that provide results, biosimilars could provide affordable options to clients and, at the end of the day, offer much-needed respite for consumers.