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Value of Biosimilars to Employers


The value of biosimilars in terms of reducing the financial burden on employers and fostering competition, and the need for employer education on these value points is discussed.


Mohannad Kusti, MD, MPH: Next I want to talk about, from my perspective, the value of biosimilars to different employers. The main thing that we see right now in the specialty medication realm, and particularly biologics, is that the costs of treatments are constantly increasing. Although we are grateful that more medications are coming into the market to help address clinical conditions and diseases that in the past we weren’t able to treat, such as oncology, we also see a potential significant financial burden on employers—particularly the ones that are self-insured or self-pay—to continue to support the members under their plan with these high-cost medications. Having the biosimilars, in addition to the biologics, will help provide the same or near identical health benefits with some reduction in cost. I think that’s one benefit we would see with biosimilars as they enter the market.

While keeping in mind that in certain situations, the original biologic will still be the gold standard and the best treatment for patients, there are situations where the out-of-pocket cost for the patient may be so much that they could not afford it. In that situation it’s either getting the biosimilar or not getting the medication at all. Having the employers know that and making sure that these biosimilars are available for the patient if they cannot afford the out-of-pocket cost would also be beneficial for the employer as they’re taking care of their employees and members under the plan.

Aside from the reduced cost from the payer side, we would also like to see more options in the market. Typically with more options, we’ve historically seen that causes more competition and more competitive pricing. The hope is to get to a point where there’s no longer a significant increase in cost, and a little bit more like a commodity market—close to that—where certain medications that belong to a certain class, such as supportive care or oncology or tumor necrosis factor blockers, would be at almost a standardized pricing, so that the patient, the health plans, the PBM [pharmacy benefit manager], and the employers can all plan accordingly how they’re going to support the patients to continue to receive those treatments.

I am still seeing that there is a little bit of either misunderstanding or lack of complete knowledge from the employers’ side, as well as the PBM and the organizations that act as pharmacy benefit consultants. I believe that more education is required. It is a new area for the United States. It’s not a new area in Europe since the European market has been using biosimilars for so many years and have really advanced in the understanding and utilization of biologics and biosimilars. But here in the United States, I think we still have a lot of time needed to learn about them. A lot of the people who are making decisions are not from a medical background. You’re talking about either the human resources team members or benefit employees, total rewards. These are all folks who may have some knowledge, but not to the extent that a pharmacist or a physician would have. So I believe there is still work that needs to be done for the employers to completely understand the value of biosimilars.

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