Biosimilars: A Proven Cost-Saving Tool But Don't Let PBMs Stand in the Way

September 08, 2025 Biosimilars are safe, clinically equivalent alternatives to costly biologic drugs. They were developed to lower drug costs and expand access to care. Despite their growing availability, adoption has been far slower than expected.

The biggest reason is the way pharmacy benefit managers (PBMs) restrict access. Many PBMs exclude biosimilars from formularies, bury them under prior-authorization requirements or promote private-label versions at inflated costs to protect their rebate revenue. Employers, stop-loss carriers and TPAs end up paying more than they should while PBMs pocket the difference.

Biosimilars Represent Opportunity

Biologics are some of the most expensive treatments in healthcare. They drive large-dollar claims, strain pharmacy budgets and contribute heavily to stop-loss exposure. Biosimilars introduce competition and make it possible to control those costs. With a steady stream of FDA-approved biosimilars entering the market, the opportunity to save is only increasing.

According to Bruce D. Roffé, president and CEO of H.H.C. Group, the key to realizing the promise of biosimilars lies in education and thoughtful plan design. Employers should give plan participants clear information on the clinical equivalence and cost savings biosimilars provide and reassure members already on brand-name drugs that switching will not compromise their care. Employees should also be encouraged to speak with their physicians about whether a biosimilar can be used in place of a higher-cost drug.

Plan sponsors can strengthen adoption by updating benefit designs and providing members with practical tools such as real-time benefit lookups and cost calculators. Extending education to providers is just as important, since physician awareness and confidence play a major role in utilization. Resources from the FDA, available at www.FDA.gov/biosimilars, can support both member and provider education.

Without proactive communication and a clear strategy, the cost-saving potential of biosimilars will remain largely untapped.

Why PBMs Resist Biosimilars

PBMs earn the bulk of their revenue from rebates tied to high-cost brand-name drugs. Because biosimilars have lower list prices, they generate smaller rebates. That makes them far less profitable for PBMs.

As a result, PBMs often work against biosimilar adoption. They impose barriers that make it harder for plan members to access lower-cost options. What should be a straightforward path to savings becomes a maze of restrictions that benefit PBMs and hurt payors.

This is not inefficiency. It is a deliberate strategy that keeps healthcare costs higher than they need to be.

How H.H.C. Group Helps

H.H.C. Group cuts through PBM barriers to ensure biosimilar savings reach the plans and members they were designed to benefit. Unlike PBMs, the company does not profit from rebates or inflated pricing. Its singular focus is reducing costs for clients.

H.H.C. Group works with plan sponsors, TPAs and stop-loss carriers to design benefit strategies that place biosimilars at the center of cost-control efforts. The team provides education for both members and providers on safety and savings opportunities, while independent reviews validate prescribing decisions and guard against unnecessary use of high-cost brand-name drugs. These efforts are backed by measurable, defensible results.

Current clients are already realizing significant savings through this approach. Those not yet partnered with H.H.C. Group are likely paying more than they should.

What Sets Us Apart:

• Attorney-Led Claim Negotiation: Slash large-dollar claims by up to 90%, even with PE-backed providers.
• Access to Major Preferred Provider Networks: Leverage existing agreements to maximize savings on claims down to $1.
• Independent Reviews/Utilization Reviews: Maintain plan integrity with unbiased medical necessity reviews by board-certified specialists — trusted by payors to validate care and support defensible decisions.
• Reference-Based Pricing: Anchor payments to fair, transparent benchmarks — not inflated fee structures.
• Fast Turnaround: Most claims resolved in 5–7 business days to keep you ahead of aggressive billing tactics.
• 30 Years of Proven Results: With a proven 30-year track record of successfully negotiating both in- and out-of-network facility claims, H.H.C. Group remains a trusted partner for cost containment nationwide.

Take Back Control of Drug Costs

The biosimilar pipeline is growing and the opportunity to save is real. Without the right strategy, PBM restrictions will continue to keep those dollars out of reach.

H.H.C. Group helps plan sponsors, TPAs and stop-loss carriers take control. With proven strategies, independent reviews and decades of results, the company ensures biosimilars deliver meaningful savings for both plans and members.

Now is the time to make biosimilars part of your cost-containment strategy. Contact HHC Group today to see how we can help you capture the savings your plan deserves.

Real People. Real Savings.