Recipe for Affordability: One Dash Biosimilar, One Pinch Health IT

Biosimilars have come to market. The FDA has given the green light to 40 biosimilars as of December 2022, and there are more to come. This could mean better access to medication that doesn’t burn a hole in the patient’s wallet.

Biosimilars are functionally equivalent to biologics—medications made from living, organic cells. Both biologics and biosimilars have proven effective at treating many chronic conditions ranging from psoriasis to cancer.

Much like traditional generic and brand-name medications, biosimilars are often much less costly than biologics. And there has been significant competitive pressure to offer biosimilars at a lower price for therapy after the original biologic loses patent protection. Take, for example, this bestselling biologic. When the patent expired, the door opened for a cheaper biosimilar.

This matters to medication affordability, even if the biosimilar costs just a little less than the biologic. Specialty medications make up 2% of prescriptions but represent 50% of overall drug spending in 2022. It may well be true, in this case, that “small price cuts for expensive drugs matter more than large cuts for cheap ones.”

But the fact that cheaper biosimilars exist is just one part of the recipe. The other part is technology that gets these biosimilars into patients’ hands (or, rather, into their arms and veins as injections or infusions).

Pharmacy benefit managers (PBMs) are taking steps to include biosimilars in their formularies, which points to the larger trend: Biosimilars are here to compete with the higher-priced brand-name biologics.

But do prescribers know this? Not necessarily.

There’s a lot more that goes into patient care than actual, face-to-face patient care. The administrative burden includes paperwork, phone calls and faxes, which nibble away at time. Prescribers don’t have the time to parse PBM formularies. Even if they had the time, the brand-name biologic is a known and recognized option, even if it’s more expensive.

But if affordability (and adherence) is the goal, it makes sense to give busy prescribers the information they need for an informed decision when they’re prescribing.

That comes down to technology at the point of care, like Real-Time Prescription Benefit.

Real-Time Prescription Benefit gives prescribers access to cost and coverage information—at the patient-specific, plan level—through a single, trusted connection. And as PBMs add biosimilars to their formularies, they are including information on these medications for the prescriber to review at the point of care.

That’s a good recipe for affordability and adherence.

Go deeper on how we’re partnering across healthcare to enhance medication affordability and adherence.