What Are Biosimilar Medications and How Do They Affect My Prescription Coverage?

Have you ever looked at your prescription drug list and come across something called a biologic medication or its cousin, a biosimilar, and thought, what does that even mean? 

You’re not alone! These terms are becoming more common, especially as more insurance carriers shift their formularies to include biosimilars. We’ll break down what biologics and biosimilars are, how they’re different from generics, and what you should know when reviewing your insurance plan’s prescription coverage. 

What is a Biologic Medication? 

Biologic medications are highly complex drugs made from living cells. Unlike traditional medications (which are chemically synthesized and easy to replicate), biologics are developed using advanced biotechnology and are used to treat a wide variety of conditions such as: 

• Rheumatoid arthritis
• Crohn’s disease
• Certain cancers
• Psoriasis
• Diabetes

These medications have revolutionized treatment, but they often come with a steep price tag, some costing between $1,000–$3,000 per month, and in certain cases $5,000 or more per week. 

What is a Biosimilar Medication? 

To help lower these costs, the FDA approved the first biosimilar medication in 2015. A biosimilar is essentially a highly similar version of an already approved biologic (called the reference product).  Made from the same biological processes, biosimilars have no meaningful difference in safety, potency, or effectiveness. 

The major benefit? Cost savings. Biosimilars are typically 15–30% less expensive than their reference biologics, making them a budget-friendly alternative without compromising on treatment quality. 

Are Biosimilars Just Generics? 

Not quite. While both biosimilars and generics aim to provide more affordable versions of brand-name drugs, their development process and chemical complexity are very different. Here’s a quick comparison: 

Why Does This Matter for Your Insurance? 

Many insurance carriers are now favoring biosimilars over biologic medications in their prescription drug coverage. Why? Because they offer the same clinical results at a lower cost, for both the insurance company and you. 

That means, if you’re prescribed a biologic, your insurance may encourage — or even require — switching to a biosimilar, unless your doctor provides a medical necessity for the original biologic. 

What Should You Do?

If you’re unsure whether your prescription plan covers a biosimilar, or if you’re concerned about switching, here are a few helpful steps: 

• Check your insurance plan’s formulary: This is the list of drugs covered by your plan. It usually highlights preferred medications (which often include biosimilars). 
• Create an online account or download your carrier’s app: This makes it easy to search for your medication, check costs, and even compare alternatives. 
• Talk to your doctor or pharmacist: They can help explain your options and request exceptions if needed. 
• Reach out to your HR team or benefits advocate (that’s us!): We’re here to help you navigate your options and understand how changes affect your costs and care. 
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The Bottom Line

Biosimilars are safe, effective alternatives to high-cost biologics and are becoming a growing part of modern prescription plans. Understanding how they differ from generics, and knowing what to look for in your carrier’s drug list, can help you make more informed, confident decisions about your care. 

Still have questions? Reach out to our Employee Advocate Team at 855-662-1029 or AdvocateServices@morrisgarritano.com.