PBMs Are Breaking Down Barriers to Expand Access to Biosimilars and Lower Consumer Costs

While Drug Companies Drive Up Drug Prices with Anti-Competitive Behavior, PBMs Continue to Innovate and Lower Costs for Consumers

As policymakers tackle America's prescription drug affordability challenge, it's important to remember that Big Pharma sets the price of the prescription drugs - and the price is the number one problem when it comes to Americans facing difficulty affording their prescription drugs. Drug companies raise drug prices year in and year out, often in January and again in July; increases averaged 5.4% in Q1 2024.

Setting and raising exorbitant drug prices isn't the only way Big Pharma drives up costs. Drug companies also engage in anti-competitive practices and abuses of the patent system to hinder lower cost alternatives, including biosimilars - biological drugs with no meaningful differences from FDA-approved reference biological products - from coming to market. Across the top 10 selling drugs, there are an average of 74 granted patents per drug. Creating patent thickets will cost patients an estimated $167 billion for just three of the top ten drugs that have no competition in the market.

The pharmacy benefit manager (PBM) industry applauds legislation aimed at cracking down on pharma's anti-competitive practices. While policymakers debate patent reform and regulations to accelerate competition, PBMs are innovating and adapting to changing market conditions to help patients access biosimilars.

PBM Innovations
Putting Patients at the Center

As the biosimilar market continues to develop, PBMs are working with employers and other health plan sponsors to break down the barriers surrounding biosimilars and make them more accessible and affordable. On average, biosimilars cost 50% less than their biologic reference products and have saved $36 billion since the first biosimilar was introduced in 2015. Below are five important ways that PBMs are working to promote biosimilars:

1. Offering a program to plan sponsors with select Humira biosimilars available for $0 out of pocket for eligible patients through a manufacturer copay assistance program.
2. Ensuring patients have affordable access to biosimilars by recommending placement on formularies.
3. Educating patients on biosimilars and creating a space for patients to speak with an expert to address their specific questions and concerns.
4. Incentivizing the use of biosimilars by offering eligible customers the option to receive a one-time payment for health care services and products if they switch to a biosimilar or another preferred medication.
5. Providing education to health care providers on how to transition their patients to new biosimilar products.

Promoting access to biosimilars is just one of the ways that PBMs are responding to an evolving market and innovating to meet the needs of consumers. Policymakers should recognize the numerous ways the drug supply chain is changing and PBMs are adapting and reject misguided proposals that would disrupt the progress already underway.

This is the second post in PCMA's PBM Innovation Project series, highlighting how PBMs are putting patients first and responding to market demands.

Read more about these innovative programs HERE.

Explore the full PBM Innovation Project HERE.

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PCMA is the national association representing America's pharmacy benefit companies. Pharmacy benefit companies are working every day to secure savings, enable better health outcomes, and support access to quality prescription drug coverage for more than 289 million patients.