Millions of Americans are currently facing a difficult choice: either pay for expensive biologic medications or ration doses to afford basic needs. Cost-related nonadherence (CRN) is where patients either skip or delay their medication due to cost concerns, a challenge that is widespread throughout the U.S. The financial burden is even greater for those managing multiple chronic conditions, where prescription costs can quickly add up to unmanageable amounts.
Despite the financial strain, biosimilars—lower-cost alternatives to expensive biologics—remain vastly underutilized. Although there are currently 64 biosimilars that are FDA-approved, they account for just 2-3% of the U.S. biologics market. This stagnation persists despite biosimilars costing, on average, 50% less than their brand-name counterparts and being projected to save the U.S. healthcare system up to $54 billion over the next decade. These savings could directly benefit patients struggling with CRN, yet many are unaware that lower-cost alternatives even exist, while physicians often lack the tools to prescribe them effectively.
The problem isn’t just affordability; it’s access, awareness, and the logistical challenges providers face when transitioning patients to biosimilars. However, automation is emerging as a solution to close this gap, helping physicians more easily identify and prescribe biosimilars the moment they become available.
Why Aren’t More Patients Benefiting from Biosimilars?
Biosimilars have been widely recognized as a key solution for high drug costs, yet their adoption rates remain low. Generics saw similar resistance when first introduced in 1984, but now enjoy widespread use. Biosimilars are following a similar path in gaining traction, with one of the biggest barriers being physician awareness. Although biosimilars have been available in the U.S. since 2015, many providers remain unfamiliar with which options are available, how they compare to brand-name biologics, or when they become formulary-preferred. Without clear guidance, physicians may continue prescribing expensive brand-name medications simply because the process of transitioning to a biosimilar is unclear or administratively complex.
Another challenge to biosimilar adoption is prescription workflow inefficiency. Physicians rarely receive real-time alerts when a biosimilar is added to their patient’s formulary, leaving them unaware that a lower-cost option is available to prescribe. The lack of upfront education for both providers and patients has contributed to the widespread hesitation around biosimilar adoption despite these drugs offering the same safety and efficacy as their brand-name equivalents.
Who is Most Affected by These Challenges?
Nonadherence due to cost exacerbates the issue. A recent study found that 17.8% of adults with asthma reported CRN, representing an estimated 2.99 million people in the U.S. Among those, 11.6% skipped doses, 12.4% took less medication, and 15.1% delayed refilling their prescriptions to save money. Nonadherence was also shown to disproportionately impact women, older adults, and non-Hispanic Black patients, emphasizing the need for targeted solutions that address affordability barriers.
Moreover, patients who experience CRN are significantly more likely to require emergency care, with data showing that they are 1.95 times more likely to experience asthma attacks and 1.63 times more likely to visit the ER due to asthma-related complications.
With rising biologic costs, many patients could benefit from biosimilars, but without physician-driven prescription changes, they will continue to pay more or skip treatment. The key to unlocking the cost-saving potential of biosimilars lies in seamlessly integrating them into physician workflows so that prescribing these alternatives is as simple and intuitive as prescribing a brand-name drug.
How Automation is Transforming Biosimilar Adoption
New advancements in AI-driven prescription management are streamlining biosimilar adoption by giving physicians insights into lower-cost alternatives and automated notifications for when a formulary update makes a biosimilar available. These technologies help bridge the gap between affordability and access by ensuring that cost-effective treatment options are easily prescribed the moment they become available.
Automation improves biosimilar adoption in several ways:
- First, it eliminates the burden on physicians to manually research formulary updates. With many providers already managing busy and complex patient loads, reducing administrative barriers is crucial in encouraging adoption.
- Second, automation allows for simple prescription switching, ensuring that the transition from a brand-name biologic to its biosimilar happens without unnecessary delays. Instead of requiring patients to request a switch or adding another office visit, automated systems enable direct prescription updates once a provider approves the change. This reduces confusion, prevents treatment gaps, and ensures patients receive the most cost-effective option without added stress.
- Finally, automation plays a role in improving patient cost transparency. Many patients remain unaware when a lower-cost biosimilar becomes available, and even if they are aware, they may not know how much they could save by switching. By integrating AI-powered cost comparison tools into the prescription process, providers can clearly communicate cost-saving opportunities to patients.
Essentially, removing the friction from prescribing biosimilars allows these alternatives to gain traction without disrupting care or adding to administrative burdens. By eliminating barriers to adoption, automation ensures more patients can access cost-effective treatment without delays or additional financial strain.
What’s Next for Biosimilars?
With the increasing availability of biosimilars and the emergence of automation to support adoption, there is strong potential for wider market penetration in 2025 and beyond. Several key trends will shape the future of biosimilar integration.
- One major factor will be increased provider education and policy incentives. As healthcare systems and insurers continue to promote biosimilars as a cost-saving tool, investment in physician education will be crucial in ensuring these drugs are prescribed with confidence.
- Another important development will be the growing role of AI-powered prescription cost management. As automation tools become more sophisticated, they will not only simplify biosimilar switching but also provide deeper insights into overall prescription cost reduction strategies. This could include personalized treatment recommendations based on patient history, predictive analytics to flag potential nonadherence, and integration with value-based care initiatives that reward cost-effective prescribing.
- Ultimately, the widespread adoption of biosimilars will depend on reducing prescribing barriers, increasing physician engagement, and making cost-effective treatment options easily accessible. With automation now closing the affordability gap, biosimilars are positioned to deliver their full potential in improving healthcare affordability while maintaining high-quality patient care.
For millions of Americans struggling with prescription drug costs, these advancements mean better access to life-saving treatments without financial and administrative strain. As the pharmaceutical industry continues to progress, automation and biosimilars will be essential in shaping a more affordable, efficient, and equitable future for prescription drug management.
About Josh Canavan
Dr. Canavan is the Director of Pharmacy at RazorMetrics, where he oversees the company’s Pharmacy and Therapeutics (P&T) committee, which is responsible for the management and updating of the company’s Intervention Codex, a system of therapeutic alternatives. With a PharmD from the University of Georgia, Dr. Canavan has over two decades of experience in both retail and hospital pharmacy, as well as in healthcare technology. He played a key role in developing EHR systems for rural hospitals before joining RazorMetrics in 2019.
