Biosimilars: The Challenges and The Opportunities

Biosimilar drugs present a large potential for reducing specialty spending, but their instability and sensitivity to manufacturing present challenges as well. Biosimilars entering the market in the next few years are expected to be priced less than the reference branded agent at estimates as high as 15%. With that in mind, plan sponsors should be keeping a keen eye on biosimilar specialty drugs and the savings they can offer – but they should also be aware of the challenges posed by biosimilars.

Biologics are larger, complex proteins that are sensitive to manufacturing, storage and handling and have higher immunogenic potential compared to small-molecule drugs.

When developing a strategy for biosimilars, payers should:

  • Monitor the clinical pipeline and conduct budget impact modeling
  • Develop a formulary strategy to drive utilization to most clinically appropriate, low-net-cost drug
  • Devise a utilization management strategy supported by scientific, evidence-based guidelines
  • Implement a unique specialty pharmacy strategy aligned with payer interests
  • Provide patient and provider education on biosimilars
  • Conduct reporting to ensure appropriate clinical and cost management


To learn more about Biosimilars and MedImpact’s recommended strategies, download the full paper, Download Biosimilars: The Challenges and the Opportunities

  • Email