Biosimilars key⁢ to Addressing Drug Pricing, Access Challenges

Updated June 7, 2025
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Rising prices for essential goods⁢ and services highlight the need for transparency, especially in the complex drug pricing system. biosimilars represent a cost-effective option for patients managing chronic diseases, offering similar benefits to biologic treatments at‍ a lower price.

Biologic drugs have transformed the treatment of conditions like cancer ⁣and rheumatologic diseases as the late 1990s. Though, their complex production leads to high costs and intricate administration, frequently enough requiring injections or infusions.

Biosimilars, as cost-saving alternatives, face hurdles despite FDA approval pathways designed to ensure their effectiveness and patient safety. Dr. Colin Edgerton, a rheumatologist, testified before Congress about barriers to‍ accessing‍ these medications, citing ‍flawed reimbursement policies and profit-driven practices by insurers and⁢ pharmacy benefit managers (PBMs).

The American College of Rheumatology has long advocated for better biosimilar reimbursement. Medicare Part D’s cost-sharing structure and PBM underpayments create a⁤ gap ‍between the cost of acquiring and administering biosimilars and physician reimbursement, impacting patient access.

While biosimilars are initially 15% to 35% cheaper than their reference drugs, these savings often don’t reach patients due to Part D cost-sharing rules.A 2018 study showed⁢ that ⁤while 96% of Part D plans covered the biologic infliximab, only 10% ⁤covered its biosimilar, infliximab-dyyb. Patients often ⁢faced higher costs for the biosimilar despite its lower list price.

Reimbursements below acquisition costs further⁢ limit biosimilar use. PBMs negotiate ⁣rebates with manufacturers, influencing formulary placement but not reducing the cost for physician practices.‍ This can lead to practices losing money when prescribing biosimilars.

This especially⁣ hurts smaller, self-reliant, and rural rheumatology practices. Dr. Edgerton ⁣detailed ‍proposals in his congressional⁣ testimony to address these challenges and ⁢improve patient access to biosimilars.

“The lack of⁢ transparency in drug pricing and the profit-driven PBM rebate system are distorting the marketplace and preventing patients from ‍benefiting from the cost savings that these innovative⁢ treatments could provide,” Edgerton said.

What’s next

Congress and the administration are urged to collaborate ⁢on ⁢increasing transparency in drug pricing to create a fairer marketplace for ⁢both providers and patients, ensuring wider access to cost-effective biosimilars.