It’s an indisputable fact: Biologic drugs revolutionized the way we treat many serious diseases. But there’s a downside. Biologics are produced using a living system, such as a microorganism, plant cell, or animal cell. Because of their complexity the development of these drugs can exceed $2 billion1, and the cost to the consumer can be extremely high — too high for too many people to afford the medicines they need.

That’s where biosimilars come in. Similar in concept to generics, biosimilars are a safe and effective treatment option for many of the same illnesses treated with biologics, but they’re nowhere near as expensive. The cost savings are passed down to the consumer, making lifesaving medications more affordable.

But the importance of biosimilars is even bigger than that. Not only do they help more people realize healthier lives, they’re also necessary to bring biotechnology affordability to the marketplace. We simply can’t afford to stay committed to the big-name biologic brands. If we do, prices will never come down.

Oh, and there’s this little fact: The biosimilar industry will cease to exist if people don’t move to it. If we stay with the brand medications and biosimilars drop out, brands will stop offering discounts, essentially giving them a lifetime patent and ensuring every other biotech drug can name its price. That’s not good for the consumer. The system is broken: Nearly half of consumers (49.5%) said they’ve abandoned a prescription at the pharmacy within the past few years because it was too expensive.2 Biosimilars are one way to help fix the brokenness.

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If there’s one big message about biosimilars it’s this: Just because they cost less, the consumer doesn’t get less. Biosimilars save consumers money without compromising the quality of care.

Biosimilars are as effective and safe as their biologic reference products. The U.S. Food and Drug Administration (FDA) has specific standards for biosimilars that must be met. To be called a biosimilar drug, it must be shown to be as safe as, work as well as, and work in the same way as its reference drug.

Our approach at Prescryptive always puts efficacy and quality first. It doesn’t matter how inexpensive a biosimilar is, we will never use it if the quality isn’t what we think it should be. We don’t start with “how much does it cost?” We start with “How well does it work?”

Rebates are not that great

The big-brand biologic drugs often offer big-time rebates. Getting money back can seem like a smart deal at first. However, the number that really matters is the bottom-line net cost. Wouldn’t you rather spend $1000 with a small rebate than $5000 with a bigger rebate? If you think about it, a big rebate means you made an interest-free loan to a multi-national conglomerate before you get your own money back. It’s like an income tax refund — the bigger the refund, the more you need a better accountant to ensure you withhold less.

As a PBM acting as a fiduciary, we don’t play games with our customers’ trust or bottom line. We consider ourselves the pharmacists in your pocket, putting the best interest of people ahead of profits. Prescryptive might not help you grab the biggest rebate, but we will help get you the lowest net cost. That’s why we’ve empowered our formulary by removing the big brand and replacing it with a biosimilar.

Making healthcare work for everyone

I’ve been managing formulary and benefits design for more than 30 years. For me it’s always been about helping people manage their conditions at prices they can afford. We all deserve access to quality healthcare, but somebody has to help keep the system under control so people can get the medications they need. I’m proud to be one of those somebodies at Prescryptive.

1 Pfizer
2Healthcare Finance News