Forbes November 10, 2024
Beginning in 2023, five years after their European counterparts, patients in the United States prescribed the autoimmune disease treatment Humira could finally choose from lower-priced biosimilars. However, the rebate game played by drug manufacturers and pharmacy benefit managers in the U.S. limits optimal biosimilar competition. As a result, U.S. patient out-of-pocket costs are too high.
Employers, health plans and government agencies contract with PBMs for services, which include negotiating prescription drug prices and managing formularies—lists of outpatient pharmaceuticals covered by payers. Here, rebating plays a critical role. Drug makers offer PBMs rebates which reduce net prices in exchange for preferential positioning on formulary, which in turn can move market share. Though PBMs pass through a large portion of these payments...
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