Biosimilar Uptake Challenges: Low-Cost Specialty Drugs Reduce Provider Profits

Guidehouse Study Featured in Specialty Pharmacy Times

Biosimilars are heralded as an affordable alternative to expensive biologic medications. Despite their potential to reduce the overall cost of treatment, prescriber uptake has been slow. The primary barrier points towards the current reimbursement model: “buy-and-bill.” CMS incentivizes biosimilar use through differential reimbursement, but private payers generally do not use this approach.

In a study conducted by Guidehouse, investigators examined the dynamics across provider types to determine the impact of provider setting and payer mix on biosimilar adoption. The health care system uses the buy-and-bill reimbursement model because biosimilars are administered by injection or infusion. Under this structure, providers are reimbursed for biologics with an additional percentage of the product price added to cover acquisition, storage, and dispensing costs associated with care, according to the report. 

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