Forbes March 5, 2025
Pharmacy benefit managers take different approaches to controlling patient access to biosimilars. Coverage of these cheaper versions of expensive biologics, such as the blockbuster autoimmune therapeutics Humira (adalimumab) and Stelara (ustekinumab), varies significantly from one PBM to another.
As intermediaries in the prescription drug supply chain, PBMs negotiate prices and manage lists of medicines which are reimbursed under patients’ pharmacy benefit. They do this on behalf of health insurers and a wide variety of employers, managing the drug coverage for roughly 266 million Americans. Here, they determine which medications get covered and which have preferred status with fewer conditions of reimbursement such as the use of prior authorization protocols.
PBMs’ management of patient access to lower-priced biosimilars has come under...
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