4 Must-Haves for a Successful Biosimilar Strategy

As biosimilars continue entering the market at a rapid pace, plan sponsors have a growing opportunity to reduce pharmacy spend without compromising clinical outcomes. But capturing those savings is not as simple as adding a lower-cost product to the formulary.

A successful biosimilar strategy requires speed, ongoing market evaluation, aligned incentives, and a keen eye on cost analysis. With new products launching across high-cost categories, plans that fail to adapt quickly may miss out on meaningful savings opportunities.

Biosimilars are designed to provide comparable clinical outcomes to their reference biologics, often at a lower overall cost. However, market dynamics, rebate structures, formulary positioning, and contracting strategies can significantly impact whether those savings are actually realized.

The most effective biosimilar strategies typically focus on four key areas.

1. Focus on Speed to Market

Timing matters.

PBMs and plan sponsors that rapidly evaluate and implement biosimilars are often better positioned to capture savings early. Delayed adoption can result in continued spend on higher-cost reference products long after clinically appropriate alternatives become available.

A proactive strategy includes continuous monitoring of the biosimilar pipeline and a structured process for timely formulary review and implementation.

2. Lowest Net Cost Evaluation

Not every biosimilar opportunity should be approached the same way.

Each product should be evaluated individually using a comprehensive analysis of total net cost, clinical equivalency, member disruption, and long-term plan impact. In some cases, the reference product may still provide the lowest net cost after all financial considerations are evaluated. In others, the biosimilar may offer significantly better value.

The key is ensuring decisions are driven by what is best for the plan sponsor and member — not by financial incentives tied to a specific product.

3. A “WAC-Nostic” Approach

Wholesale Acquisition Cost (WAC) alone does not tell the full story.

Some biosimilars enter the market with a high-WAC/high-rebate structure, while others use a low-WAC approach with fewer or no rebates attached. A successful biosimilar strategy should remain “WAC-nostic,” meaning products are evaluated based on total net cost rather than list price alone.

Preference for either high-WAC or low-WAC products can create unnecessary limitations and may prevent plans from achieving the best financial outcome.

4. Continuous Market Monitoring

The biosimilar landscape continues to evolve quickly.

New entrants, pricing shifts, and competitive contracting strategies can alter the economics of a therapeutic category. Ongoing monitoring allows plans to adapt strategies over time rather than relying on a one-time formulary decision.

Successful biosimilar management is not a static initiative, it requires continuous evaluation.

Why Incentive Alignment Matters

As biosimilar competition grows, incentive alignment becomes increasingly important.

Financial arrangements that reward higher drug spend or prioritize rebate volume over total net cost can create conflicting motivations. Independent clinical oversight and transparent evaluation processes help ensure formulary decisions remain focused on plan sponsors and members rather than profit.

When implemented effectively, a biosimilar strategy can help balance three critical priorities:

• Lower overall drug spend
• Strong clinical outcomes
• Minimized member disruption

At SlateRx, our approach to biosimilars is built around independent clinical review, aligned incentives, and a comprehensive net cost evaluation process designed to prioritize the best outcome for plans and members. This allows us to implement biosimilar strategies that focus on long-term value, member experience, and sustainable savings for plan sponsors.

To learn more, our clinical team would be happy to connect at clinicalstrategy@slate-rx.com.