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This type of drug may help prescription costs

The basics of biosimilars

It’s no secret that the cost of prescription drugs is rising. In fact, according to research from the Kaiser Family Foundation, 24 percent of Americans find it difficult to pay for their prescriptions External Site and 29 percent skipped doses because of the costs. 

With a health insurance plan from Wellmark Blue Cross and Blue Shield, you can save money on prescriptions by talking to your pharmacist or personal doctor about your options and asking for generics, when possible. You may also be able to take advantage of pharmacy and drug innovations, like biosimilars.

What is a biologic drug?

Before we can explain biosimilars, we need to talk about biologics. Biologics are drugs made from a mixture of components (sugars and proteins, for example). They’re different from more traditional, chemically manufactured drugs because they’re so complex. Biologics include a wide range of treatments, such as:

Some of the most commonly used biologic drugs External Site treat various autoimmune diseases, cancers and diabetes. These types of drugs can be extremely expensive and often require approvals for use from both your doctor and health insurance company.

What is a biosimilar drug?

While biosimilar drugs are not the same as generic drugs, they’re kind of like a generic version of a biologic. According to the Food and Drug Administration (FDA), a biosimilar is a biologic that is highly similar External Site to and has no meaningful differences from an existing FDA-approved product.

Biosimilars are safe, effective treatment options External Site that can potentially lower the cost of prescription drugs and increase people’s access to life-saving treatment.

What do I do if a biosimilar is available for my prescription drug?

At this time, the majority of biosimilars are only available in the hospital setting or administered by a provider. So, if you’ve ever used a biosimilar, it was likely injected or infused by your doctor.

It’s expected that more biosimilars that you can give yourself will be available soon. The next self-administered biosimilar expected is Humira®, a commonly-used specialty medication that treats many autoimmune conditions, including rheumatoid arthritis, psoriasis and Crohn’s disease.

If you're currently on a biologic medication, talk to your personal doctor about a biosimilar option that's been approved or might soon be approved for your condition. If there's one available, you will not be required to switch at this time. However, it might provide you with a safe, effective and less costly treatment option. 

Do biosimilars require prior authorization?

Some prescription drugs — and certain amounts of some drugs — require an approval called prior authorization before they can be covered by your health insurance benefits. To determine if a biosimilar requires prior authorization, register or log in to myWellmark® Opens New Window or check the authorization and quantity limit drug list Opens New Window.

Remember, it's always important to have an open, honest relationship with your provider so you can advocate for your own health and understand prior authorization requirements that may be needed. 

Stay up-to-date on your prescription drug benefits

The best way to know your benefits and save on prescription drug costs is to log in to myWellmark Opens New Window. With myWellmark, you can:

  • Know your out-of-pocket costs before your office visit or before you pick up your prescription.
  • Easily check your copayments, deductibles, and out-of-pocket maximums.
  • Get personalized tools and real-time information about your Wellmark coverage.

You can also check out other prescription-related stories here on Blue for the latest on prescription drug trends and how to better understand your benefits.