Slash Costs & Boost Care: The Role of Biosimilars Workers’ Comp!
As specialty drug prices soar, workers’ compensation systems are caught in a tough balancing act—delivering quality care while keeping costs in check. Specialty medications alone can eat up 5-10% of total pharmacy spend[4], and biosimilars—though more affordable than their reference biologics—can still be up to 40 times the cost of traditional meds[4].
So, what’s the big deal with biosimilars?
Biosimilars are FDA-approved alternatives to biologic drugs, offering the same efficacy and safety—without the hefty price tag [6]. As they gain traction, they’re becoming a key player in reshaping cost management in workers’ compensation.
Why Biosimilars Matter in Workers’ Compensation
Biologic drugs have been game-changers for treating complex conditions like inflammatory diseases, oncology, and autoimmune disorders—all common in workers’ comp cases. But their sky-high costs have put serious pressure on payers.
Enter biosimilars, a cost-effective alternative that doesn’t compromise on quality. For example, biosimilars for Remicade® (infliximab), Humira® (adalimumab), and Enbrel® (etanercept) are widely used to treat rheumatoid arthritis and severe back pain[1]. By switching to biosimilars, workers’ comp systems can cut costs without cutting care—a true win-win for injured workers and payers alike. Biosimilars aren’t just an option—they’re the future. And in a world where every healthcare dollar counts, that’s a future worth embracing.
Why Biosimilars Are a Win for Patient Care
Better Outcomes, Smarter Treatment – Like biologics, biosimilars take a precision-targeted approach, honing in on specific disease pathways for more effective treatment.
Fewer Side Effects, Better Quality of Life – By zeroing in on the right targets, biosimilars minimize side effects and reduce the need for extra medications, lowering the risk of complications.
Proven Safety, Same Life-Saving Benefits – Studies show that biologics have significantly reduced mortality rates, and switching to biosimilars delivers the same survival benefits—without added risk.[8,9]
Biosimilars aren’t just cost-effective—they’re clinically effective.
Cost Savings Potential [5]
Lower Costs, Bigger Savings – Biosimilars can be up to 50% cheaper than their reference biologics, delivering immediate cost relief for payers.
More Competition, Lower Prices – As biosimilars enter the market, they disrupt the biologics monopoly, driving prices down across the board.
Formulary Flexibility – Adding biosimilars to state-mandated workers’ comp formularies ensures consistent use and maximum savings.
Cutting Hidden Costs – Fewer side effects mean less reliance on additional meds and fewer hospital stays, keeping long-term costs in check.
Potential Limitations of Biologics and Biosimilars [5]
Patient-Specific Fit – Not a one-size-fits-all solution! Careful selection and monitoring ensure each patient gets the right treatment.
Adherence Matters – Biosimilars only deliver results when patients stick to their regimen. Poor adherence can increase employer costs and impact worker productivity.
Clinical Experience vs. Abbreviated Approval – While biosimilars undergo a streamlined approval process, they remain highly similar, safe, and effective alternatives to their biologic counterparts.
Biosimilars offer big benefits—but require smart management to maximize their impact!
Challenges to Adoption
Prescriber Hesitancy – Some physicians hesitate to switch from reference biologics due to familiarity or lingering efficacy concerns.
Regulatory Maze – State-specific workers’ comp rules create formulary inconsistencies, making biosimilar adoption anything but straightforward.
Patient Pushback – Injured workers may be wary of change, especially if they’ve had success with their current biologic.
Education Gaps – Many stakeholders aren’t fully aware of biosimilars' equivalency and cost benefits, slowing down progress.
Overcoming these challenges takes awareness, trust, and the right strategy—but the potential savings and patient benefits make it worth the effort!
Winning Strategies for Boosting Biosimilar Adoption
Education & Outreach
Equip prescribers with resources on biosimilars' safety, efficacy, and cost benefits.
Keep providers in the loop on upcoming biosimilar launches.
Build patient confidence through clear, accessible education.
Incentivized Formularies
Prioritize biosimilars in workers’ comp drug formularies.
Offer financial incentives to encourage prescriber and payer adoption.
Policy Advocacy
Push for streamlined state regulations to make biosimilar adoption smoother.
Real-World Evidence
Gather and share data showcasing the clinical and financial impact of biosimilars in workers’ comp cases.
The Road Ahead
With specialty drug costs climbing, biosimilars present a $53 billion savings opportunity over the next decade—but success depends on regulations, competition, and adoption strategies. By breaking down barriers and fostering collaboration, biosimilars can help reshape workers’ comp with better outcomes and lower costs. As education and awareness grow, biosimilars will play a bigger role in building a more sustainable future for injury-related care.
By Meghan Bannow
PharmD Candidate (P4)
For questions, e-mail pharmd@prodigyrx.com
Citations:
1. https://www.samsungbioepis.com/upload/attach/SB+Biosimilar+Market+Report+Q1+2024.pdf