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Examine how Medicare formulary design influences access to biosimilars and potential cost savings.

November 7, 2025Health Affairs ScholarOpen Access

Savings from Biosimilars and Medicare Formulary Access

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Evaluation of formulary access for adalimumab biosimilars in Medicare shows lower access and higher costs, indicating a need for policy reforms.

Examine how Medicare formulary design influences access to biosimilars and potential cost savings.
Evaluation of formulary access for alimumab biosimilars compared to innovator drug in Medicare Part D.
Analysis of coinsurance costs associated with adalimumab biosimilars versus fixed copays for generic drugs.
Assessment of FDA policies aimed at simplifying biosimilar development requirements.
Formulary access for adalimumab biosimilars is lower compared to the innovator drug.
Beneficiaries face higher coinsurance costs for biosimilars compared to fixed copays for generics.
The slow growth of the US biosimilar market limits potential cost savings.

Axelsen et al. (2025) studied this question.

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Evaluation of formulary access for adalimumab biosimilars in Medicare shows lower access and higher costs, indicating a need for policy reforms.