Big Pharma Continues to Undermine Competition, Setting High Drug Prices to Boost Profits

As the House Ways and Means Subcommittee on Health today holds a hearing on biosimilars, it’s important to highlight how pharmacy benefit companies are responding to changes in the market. PBMs are working with employers and other health plan sponsors to break down the barriers surrounding biosimilars and make them more accessible and affordable for patients.

To be clear, PBMs support lower drug prices and have long been strong proponents of a highly functioning biosimilar market and advocate for policy changes that will increase generic and biosimilar use. Unfortunately, while PBMs work to increase access to biosimilars, Big Pharma continues to set and increase the price of drugs by exploiting loopholes and manipulating the system to delay lower-cost affordable options from being able to come to market.

PBM programs on biosimilars include:

• Offering a program to plan sponsors with select Humira biosimilars available for $0 out of pocket for eligible patients through a manufacturer copay assistance program.
• Ensuring patients have affordable access to biosimilars by recommending placement on formularies.
• Educating patients on biosimilars and creating a space for patients to speak with an expert to address their specific questions and concerns.
• Incentivizing the use of biosimilars by offering eligible customers the option to receive a one-time payment for health care services and products if they switch to a biosimilar or another preferred medication.

• Providing education to health care providers on how to transition their patients to new biosimilar products.

These efforts are paying off. According to data from SSR Health, the introduction of biosimilar competition for Humira has already led to a significant decline in net prices—a proof point that biosimilars can meaningfully reduce drug costs when allowed to compete.

Despite this progress, Big Pharma continues to engage in anti-competitive practices – like patent thickets –to undermine lower cost alternatives, like biosimilars, from coming to market to protect their profits.

Read more about how PBMs are breaking down barriers to expand biosimilar access HERE.

Explore more about how PBMs are innovating to respond to evolving consumer and employer demands HERE.

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PCMA is the national association representing America’s pharmacy benefit companies. Pharmacy benefit companies are working every day to secure savings, enable better health outcomes, and support access to quality prescription drug coverage for more than 275 million patients.