How biosimilars increase transparency and help you save

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A growing class of complex medications known as biosimilars is helping to curb the cost of specialty drugs without sacrificing safety or effectiveness.

These products — designed to help control pharmacy costs — create a sustainable health care system and achieve affordability for you and your employees.

Cutting pharmacy spend with biosimilars

What are biologics and biosimilars?

Biologics are complex drugs made from natural sources, living sources and microorganisms. They can be made of living cells, tissues, sugars and proteins. Biologics include a wide range of products, such as:

• Vaccines
• Blood and blood components
• Gene therapy
• Tissues

Biosimilars are FDA-approved drugs that are close copies of the biologic they are meant to replicate. Biosimilars are a growing class of cost-effective, critical treatment options for a range of conditions. More than 40 biosimilars have been approved by the FDA since 2015 and more are in development.

Many biosimilars injected or infused by a health care provider are covered under medical benefits. However, more self-administered biosimilars are becoming available and are filled by a specialty pharmacy as part of a patient’s prescription drug benefits.

Safety and effectiveness of biosimilars

To be approved by the U.S. Food and Drug Administration (FDA), studies must show that biosimilars are as safe and effective as the original biologic they are meant to replicate. Biosimilars are made from the same source materials as biologics and provide the same benefits when treating diseases and medical conditions without differing side effects.

Biosimilars provide cost-savings

Generic versions of brand name medications have been helping to manage drug prices for decades. Biosimilars offer the same opportunity for savings on costly biologic medications and are a critical component to bend an ever-rising pharmacy spend trend.

Wellmark Blue Cross and Blue Shield has developed an innovative, industry-leading approach to achieve lower costs for your organization while ensuring clinical safety and effectiveness for your employees. This involves negotiating directly with drug manufacturers to get the best prices.

Our approach also provides more transparency and predictability for employers and employees. By negotiating directly with the manufacturer for our preferred biosimilars, Wellmark is able to provide more transparent drug pricing. And, because the drug cost is so much lower, employers will see immediate savings when the medications are purchased, rather than having to wait to receive rebates, which can take months to arrive. For example, Wellmark’s preferred biosimilar for Humira^® is priced about 80 percent lower than the name-brand biologic.

Help your employees make a seamless shift to biosimilars

Wellmark aims to minimize disruption when there are changes to members’ prescriptions. All members with prescriptions for biologics, and their health care providers, are notified when there is a switch from a biologic to the preferred biosimilar. For high-use drugs, Wellmark may also contact pharmacies to ensure they have adequate supply of the preferred biosimilar available.

One helpful way to reassure employees about using biosimilars is to compare them to generic drugs. People have grown accustomed to using generic drugs as a safe and less-expensive alternative to their name-brand counterparts. Biosimilars are safe alternatives to biologics.

To help answer additional questions, the FDA has helpful resources, including the biosimilar basics for patients and an infographic to help explain this important class of medications.

Members are also encouraged to talk with their provider to learn more about biosimilars and the best option for them.