Biosimilars: Unlocking access, closing the cost divide

Every day, countless Americans are forced to choose between meeting basic needs such as food, housing, or transportation and paying for their medications.

For those with chronic conditions like asthma, arthritis, and diabetes, those decisions can carry serious health consequences. Cost-related nonadherence (CRN) – the act of skipping doses, splitting pills, or delaying refills to save money – is a major issue among US adults with chronic conditions. For instance, studies have shown that approximately 25% of adults with diabetes reported rationing insulin in the previous year due to cost concerns. This behaviour can lead to adverse health outcomes and increased healthcare utilisation.

Biologic drugs are often at the centre of this issue. They've revolutionised treatment in many specialties, but come with high out-of-pocket costs. Many patients want to stick to their treatment plan, but can't afford to. That's not just a reflection of preference, but a reflection of pressure. The frustrating part? Lower-cost alternatives are available.

Lower-cost options exist, but go unused

Biosimilars, lower-cost alternatives to expensive biologic drugs, have the potential to reduce healthcare expenditures. As of March 2025, the FDA has approved 73 biosimilar products. Despite their availability, biosimilars account for only 23% of the US biologics market, with uptake varying widely across different treatments. On average, biosimilars are priced 53% lower than their reference biologics after five years of competition. These savings could directly benefit patients struggling with CRN, yet, many are unaware that lower-cost alternatives exist, and physicians often lack the tools to prescribe them effectively.

This isn't just about availability. It's about access.

Patients rarely hear about biosimilars as an option. They remain on the more expensive drug, unaware that an alternative exists. That disconnect often begins at the prescribing level. Many physicians are not informed when a biosimilar becomes available or preferred because they may not know when their patients’ formularies change. Both doctors and patients are left in the dark.
With packed schedules and rising administrative workloads, most physicians don't have time to research alternative options. Automation is helping close this gap by streamlining the process for physicians to identify and prescribe biosimilars as they become available.

Physicians need smarter tools, not more to-do lists

Prescribing a biosimilar shouldn't take extra time or effort. When a lower-cost alternative becomes available, physicians should be able to act immediately without logging into a separate platform or navigating an unfamiliar process. New automation tools now make that possible. AI-powered systems can identify when a biosimilar is added to a plan's formulary, alert the prescriber at the point of care, and present the interchangeable lower-cost option for approval. That means the switch happens in the moment, not weeks after a patient raises a concern or the pharmacy calls with pricing confusion.

These tools don't require physicians to change their work habits. They support the existing prescribing flow by reducing friction and eliminating the extra steps that typically slow down biosimilar adoption. The benefits are immediate. When doctors are equipped to recommend biosimilars confidently, patients benefit from lower costs and uninterrupted care. There is no surprise billing, no added appointments; just a straightforward, affordable prescription.

Patients are far more likely to fill a prescription if they know it won't break the bank. But awareness is everything. Most patients aren't familiar with the term "biosimilar". They want to know if the prescription will work for them and if they can afford it. When doctors can clearly communicate that a biosimilar offers the same treatment outcome at a lower cost, it opens the door for acceptance. And when automated prescribing tools support that message, patients are no longer left to navigate affordability on their own.

These aren't just one-off fixes. When a biosimilar becomes preferred across a health plan, an automation system can help switch entire patient populations to the new option quickly and efficiently. It's not just about convenience—it's about unlocking savings on a broad scale without creating bottlenecks or adding burden to already overworked providers.

There's momentum here. More payers are making biosimilars preferred on their formularies, more pharmacy teams are exploring automation as a way to drive down spending, and more physicians are recognising technology's role in improving access without sacrificing clinical autonomy.

Barriers still exist, and education remains essential

Adoption is picking up, but hurdles remain. Many providers still have limited experience prescribing biosimilars. They may question how they compare or worry about the administrative hassle of switching patients mid-treatment. Without education and support, even the best tools can go underused. Patients, too, often equate lower cost with lower quality.

That misunderstanding can create hesitation, especially in complex conditions where stability is hard-won. Addressing those concerns requires clear communication and transparency, backed by updated coverage and pricing data access. At the system level, siloed data and outdated workflows slow down adoption. The more we can streamline the prescribing process, the more likely biosimilars will become the default, not the exception.

The path forward is practical, not aspirational

This isn't about reinventing the system. It's about making practical changes that support what doctors and patients are already trying to do: deliver and receive affordable, effective care. Smart automation, paired with trusted clinical judgment, helps make that possible. Cost-saving decisions shouldn't require extra effort or guesswork. When biosimilars are presented in a way that fits naturally into prescribing routines, supported by accurate formulary data and easy approval processes, they are more likely to be used. And when that happens, patients win.

The potential savings are tangible. The adoption of biosimilars presents an opportunity to save the US healthcare system from skyrocketing costs, freeing up resources to treat more patients and enhancing affordability. But numbers don't mean much to the patient currently rationing medication. What matters is whether their doctor can offer a better option and whether that offer is clear, accessible, and easy to act on.

Closing the gap for good

There's no shortage of interest in fixing drug affordability. However, solutions only work when they fit the real-world demands of modern healthcare. Biosimilars represent one of the most promising avenues for relief, but they'll only reach their potential if we give physicians the tools to prescribe them without delay or confusion.

Automation is helping bridge that gap. It doesn't require a system overhaul. It makes it easier for doctors to do what they already want to do, which is to help their patients get better without breaking the bank. The affordability crisis isn't going away overnight, but smarter, simpler prescribing can make a difference today for the people who need it most.

About the author

Dr Josh Canavan is director of pharmacy at RazorMetrics, where he oversees the company’s Pharmacy and Therapeutics (P&T) committee, which is responsible for the management and updating of the company’s Intervention Codex, a system of therapeutic alternatives. With a PharmD from the University of Georgia, Dr Canavan has over two decades of experience in both retail and hospital pharmacy, as well as in healthcare technology. He played a key role in developing EHR systems for rural hospitals before joining RazorMetrics in 2019.