Juliana Reed, MS: The Role of PBMs in US Adalimumab Biosimilars Launch

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Although the recent launch of 7 adalimumab biosimilars should lead to cost savings and better access to medication, the role of pharmacy benefit managers raises concerns for Reed and her team.

HCPLive Rheumatology interviewed Juliana Reed, MS, executive director of the Biosimilars Forum, to discuss the recent launch of 7 adalimumab (Humira) biosimilars into the United States (US) market, bringing the total on the market to 8, and what this development means for patients and physicians.

“This is the largest simultaneous launch of biosimilars, which is highly significant,” Reed explained. “It introduces competition for Humira, which is currently the top-selling biologic worldwide. We consider it a watershed moment and a crucial event for the industry, consumers, taxpayers, and patients.”

Reed emphasized in an ideal scenario, this increased availability would lead to competition, cost savings, and better access to medicines. However, she and her team are concerned about a few factors. Firstly, access to the market is controlled by 3 pharmacy benefit managers (PBMs) that hold 80% of the market share. Additionally, the PBM model favors high-rebate products, which means companies often have to launch their products with a dual pricing structure, one with a high rebate and one with a lower price.

Some companies are exploring new models to bypass the PBMs. Currently, out of the 8 Humira biosimilars, only the high-rebate product has gained market access. This situation contradicts previous commitments from approximately a decade ago when they advocated for the creation and approval of biosimilars to bring lower-cost biologic medicines into the market. Despite the ability to provide a lower-cost product, they are struggling to gain market access without offering high rebates. The PBMs are limiting competition and access.

“This situation is a significant bellwether moment for the industry, and we are concerned about its long-term impact on development decisions and the sustainability of the biosimilar industry,” Reed stated.

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