Managing the rising cost of medications: A focus on biosimilars

Amid growing concerns over the rising costs of prescription drugs, many Iowans are struggling to afford their medications. A recent report from KFF, a nonprofit organization that provides information on health issues, showed that more than a quarter of American adults are worried about paying for their prescriptions. Additionally, employers are challenged with the rising cost of specialty medications.

One promising approach to these concerns is increased access to biosimilar medications. Biosimilars are safe and effective and significantly less expensive. This could ease the financial burden on many households.

Humira, for instance, is commonly prescribed to treat conditions like Crohn's disease and rheumatoid arthritis. Humira is among the most expensive medications on the market, costing almost $10,000 per month. In 2023, Humira was the highest prescription expense for Wellmark Blue Cross and Blue Shield, with an average spend of $16 million per month.

To help reduce health care costs for our members while maintaining access to essential treatments, Wellmark signed a direct contract with the manufacturer of a biosimilar to Humira, called Adalimumab-aacf, at the end of 2023. This led to significant savings for members and employer group customers, reducing prescription drug spending by about $48 million in 2024. Working closely with providers who prescribe Humira, more than 99-percent of those Wellmark members taking Humira switched without disruption and benefited from zero out-of-pocket costs through the PrudentRx specialty copay card program.

Biosimilar alternatives are becoming more available, offering less expensive options for select specialty medications. As of December 2024, the U.S. Food and Drug Administration (FDA) has approved more than 60 biosimilars, including 14 that are interchangeable with the original product. These interchangeable biosimilars can be substituted for more expensive brand-name medications similar to traditional generic medications.

Focusing on more cost-effective alternatives like biosimilars can lower health care expenses and improve access to necessary treatments. This is one of many innovative initiatives Wellmark is working on to manage health care costs for our members. Learn more at Wellmark.com. ABI