Banking on Affordability with Biosimilars
Biosimilars may be just the medicine to help lower our 30% total cost of care from prescription drugs. In 2024, biosimilars saved over $20 billion.* Those savings make sense to everyone.
What are biosimilars?
A biologic drug is an Food and Drug Administration (FDA)-approved medication. It’s made from living cells instead of chemicals. Biosimilars are FDA-approved medications that are designed to be highly similar to biologics. They have the same safety and efficacy as biologic drugs. A biosimilar can be used in place of a biologic.
Why biosimilars matter
Biosimilars treat complex medical conditions; for example, autoimmune diseases, some types of cancer, multiple sclerosis, and bone diseases.
“The availability of biosimilars is increasing, and they give us a way to continue to afford healthcare,” said Jennifer Wilson Norton, manager of pharmacy, Clinical Programs.
Biosimilars offer:
- Effective treatment at a fraction of the cost of a biologic
- A way for employers to reduce the cost of health benefits
- An affordable option for providers to offer their patients
- A way to drive competition and lower prescription drug costs
Premera numbers
We started covering biosimilars for Humira® in 2023. This prescription drug is used to treat conditions like rheumatoid arthritis and digestive tract disorders.
- Biosimilar use for eligible members increased from 5% in June 2024 to over 77% in 2025.
- Our goal by the end of 2025 is 90%. We’re currently at 97.4%.
In July, we also launched biosimilars for the prescription drug Stelara®. It’s used to treat the some of the same conditions as Humira®.
- Our goal by the end of the year is 80%.
- Currently, we are at 32.6%, up from 2.9% when the biosimilar was approved by the FDA.
We’ll be introducing biosimilars for Prolia®, used to treat osteoporosis, in the near future.
Emily Tsiao, senior clinical pharmacist, Clinical Operations, explains biosimilars. Healthcare Asks: What are Biosimilars
Our approach
Premera adopts biosimilars in a thoughtful way. Our goal is to have the lowest net cost for the highest quality treatment.
- The Premera pharmacy team assesses the clinical evidence of biosimilars when they become available.
- One biosimilar is helpful, but we want two to three choices for our members. This becomes important in the event of supply chain disruptions.
“We see what’s out there and what will be the best choices to make sure this is long-term,” said Julie Nelsen, pharmacy manager, Clinical Operations. “We want people to be able to switch and stay with their biosimilar.”
Making it work
Our pharmacy teams partner to advance biosimilar adoption by:
- Choosing preferred biosimilars for specific formularies
- Identifying members who are eligible for biosimilars
- Updating medical policies
- Discussing options with specialty pharmacies
- Offering general education around biosimilars to providers to gauge interest
- Communicating biosimilar options and formulary changes with employers, providers, and members
The specialty factor
At a retail pharmacy, pharmacists may know a little about a lot of medications. Working with specialty pharmacies that carry biosimilars requires high-touch planning, but it benefits our members.
“Specialty pharmacists are trained in a member’s specific medication or disease state. They provide additional education and sometimes clinical follow up,” Sherine Bolos, senior clinical pharmacist, Clinical Operations, noted.
Explore more
Feed your curiosity about biosimilars:
- Read more about the types of health conditions that biosimilars treat here.
- Check out the 2025 U.S. Generic & Biosimilar Medicines Report* (see statistic at the start of this story).