Savings from biosimilars and Medicare formulary access.

ABSTRACT: We reflect on how Medicare Part D formulary design could facilitate access to biosimilars, create cost-savings, and motivate investment in biosimilar development. We evaluated adalimumab, a self-administered biologic for inflammatory conditions with the most approved biosimilars, including interchangeable as a case study. We found that formulary access in Part D for adalimumab biosimilars is lower relative to the innovator. Moreover, when adalimumab biosimilars are on the formulary, beneficiaries typically pay coinsurance, a cost higher than a fixed copay. This is unlike generic drugs, whose coverage in most Part D formularies typically has a co-pay of $5 or less (Dusetzina SB, Cubanski J, Nshuti L, et al. Medicare Part D plans rarely cover brand-name drugs when generics are available.

SUBMITTER: Axelsen K 

PROVIDER: S-EPMC12648244 | biostudies-literature | 2025 Nov

REPOSITORIES: biostudies-literature