Reforming the System: PBM Practices Are Blocking Access to Biosimilars

In today’s healthcare landscape, few issues affect patient access and affordability as much as PBM practices. With 80% of the PBM market now controlled by just three large companies, the influence of these intermediaries on drug pricing and biosimilar access has never been greater.

Biosimilars are highly similar, safe, and effective versions of existing biologic medicines that are often more affordable treatment options. In 2023 alone, competition among these alternatives generated $12.4 billion in savings. Despite the potential to drive down prices and broaden access, PBMs have systematically undermined their adoption. The three largest PBMs have excluded biosimilars from their formularies since 2018 - with 14 biosimilars being sidelined from at least one formulary by 2022.

The impact is significant: only 1 in 3 patients prescribed a lower-cost alternative can fill their prescription, leaving these cost-saving alternatives with just a 1% market share.

When PBMs favor products with higher list prices to secure larger rebates, the broader consequences are clear. Competition is stifled, even though generics and biosimilars have saved patients and taxpayers a total of $408 billion, and patients have fewer affordable options. If PBMs continue to block access to lower-cost alternatives, these critical savings could disappear entirely.

It's time for Congress to pass real PBM reform this year.