What you'll learn from this report

Were you aware that biosimilar drugs are generally 15 to 20 percent less expensive than their biologic counterparts, and some may be as much as 30 percent less?

In this report, prepared for the ERISA Industry Committee (ERIC), we explore the biosimilar landscape as it applies to health benefit coverage. 

You'll learn about:

• The background on biosimilar manufacture
• The employer’s role in promoting biosimilars
• Increasing understanding of biosimilars by health plan participants and health care providers
• Adopting clinical management programs
• Designing the payment features of prescription drug benefits
• Addressing biosimilar drugs when negotiating PBM contracts
• The biosimilar pipeline

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Putting the biosimilar pieces together

While utilization of the handful of available biosimilars is currently low, there is positive movement towards the growth of these drugs.

Although biosimilars are still an emerging drug option, they offer another way for employers to offer high-quality, affordable drug options to their health plan participants.

Employers interested in fully exploring the benefits of offering these drugs to medical and pharmacy plan participants should work with their partners and benefit advisors, develop a go-forward prescription drug strategy including biosimilars and make efforts towards creating awareness of these drug options.

Work with partners

Employers should work with their PBMs, health plan carriers, pharmacy benefit consultants and legal counsel to understand the ongoing evolution of the biosimilar market and monitor the pipeline of new biosimilar drugs.

It is also important for employers to identify which PBMs are promoting greater use of biosimilar drugs and include biosimilar provisions and competitive payment features in their PBM contracts.

For example, as modifications are made to how biosimilars are administered or where they are administered, there may be savings opportunities for employers.

Develop a strategy

Employers interested in exploring the cost-savings potential of biosimilars should include them in their pharmacy benefit strategy. There are numerous clinical management strategies employers can take to improve the quality of care offered to plan participants while also lowering costs.

Create awareness

It is not too early to increase awareness of biosimilars through communication campaigns aimed at plan participants and health care providers.

Additionally, it may be helpful to consider how PBMs and health plan carriers will handle newly launched biosimilars. Some PBMs are already making strides by promoting select biosimilars on their formularies.