Help lower costs with biosimilars

We actively promote evidence-based use of biosimilars to help you make the most of your integrated drug strategy.

Learn more about biosimilars

A biologic drug (or biologic) is a complex medicine made from large molecules derived from living cells, distinguishing them from conventional drugs, which consist of small molecule chemicals. Biologics play a critical role in preventing and treating various chronic and high-cost specialty diseases, such as cancer, multiple sclerosis and rheumatoid arthritis. However, costs for these drugs continue to rise, further escalating the expense of managing these complex conditions.

12.5%

Since 2017, biologics spend has increased at a compound annual growth rate (CAGR) of 12.5%, far surpassing the 1.3% CAGR for conventional drugs.1

46%

Biologics now account for 46% of total medicine spend in the U.S.1

A cost-effective alternative

Biosimilars are drugs that are highly similar to, and have no clinically meaningful differences from, their FDA-approved biologic counterparts (or reference products). Although newer to the market, biosimilars are typically more cost-effective than the original biologics, providing a promising solution to rising drug costs.

$124.5B

Estimated savings from biosimilar adoption and use from 2021 to 2025 ranges from $38.4 billion to $124.5 billion.2

Embracing biosimilars to reduce costs

As part of our comprehensive drug management strategy, we actively promote the evidence-based use of FDA-approved biosimilars and other low-cost drug options. This approach is endorsed by our pharmacy and therapeutics (P&T) committee to ensure safety and efficacy.  

For instance, the recent introduction of biosimilars for Humira, a popular specialty drug, marks a significant step in this direction. These biosimilars are some of the first to be processed under the pharmacy benefit, and our adoption strategy is designed to drive savings while safeguarding member health.

Biosimilar adoption yields significant savings 

In a recent case study, three Blue Cross Blue Shield plans added biosimilars to their formularies and preferred them, resulting in $4M in savings. If all Blue Cross Blue Shield plans under Prime adopted similar strategies, projected annual savings could range between $41M and $55M.3  

A comprehensive approach to savings

Clinical rigor

Comprehensive policies, proactive pipeline monitoring and rigorous UM strategies help ensure members get the right therapies.

Expertise & predictive analysis

Macro- and micro-analytic forecasting predictions, comprehensive pipeline clinical supplements and KOL insights.

Customized formularies

We prioritize clinical effectiveness when developing formularies. And we use net costs to guide how we build tiers and the way we make coverage decisions.

Choose what works best for you and your members

Footnotes

*All brand names are property of their respective owners.
**The programs listed are not available to all clients. Please check with your representative if you are interested in learning more.
1 Biosimilars in the United States 2023-2027. (n.d.). IQVIA. https://www.iqvia.com/insights/the-iqvia-institute/reports/biosimilars-in-the-united-states-2023-2027
2 Mulcahy, A. & Buttorff, C. (July 2022). Projected US savings from biosimilars, 2021–2025. The American Journal of Managed Care, 28(7). https://www.ajmc.com/view/projected-us-savings-from-biosimilars-2021-2025
3 Internal analysis, 2024

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