Biosimilar Cost Savings: How They Compare to Original Biologic Prices

When you hear the word "generic," you probably think of cheap pills that work just like the brand-name version. But when it comes to biologics - complex drugs made from living cells - there’s no such thing as a true generic. Instead, there are biosimilars. And while they’re not exact copies, they can save patients, employers, and the healthcare system a lot of money. The question isn’t whether they work - they do. It’s why, after nearly a decade on the market, most biologic spending still goes to the original brands.

What Exactly Are Biosimilars?

Biosimilars are not like generic pills. Generic drugs are chemically identical to their brand-name counterparts. A 10mg tablet of generic lisinopril is the same molecule, made the same way, every time. Biosimilars are different. They’re made from living organisms - cells, proteins, sometimes even bacteria or yeast. That means even tiny changes in the manufacturing process can affect the final product. So instead of being identical, biosimilars are "highly similar" to the original biologic, with no clinically meaningful differences in safety or effectiveness.

The FDA approved the first biosimilar in 2015. Since then, more than a dozen have entered the U.S. market. But while generics can cut prices by 80-90%, biosimilars typically save 15-35% off the list price. That might sound low - until you realize what you’re saving on. Biologics like Humira, Enbrel, and Stelara cost tens of thousands of dollars per year. Even a 20% discount on a $20,000 drug saves $4,000 per patient annually.

How Much Do Biosimilars Actually Save?

The savings aren’t just theoretical. In 2024 alone, biosimilars saved the U.S. healthcare system $20.2 billion, according to the Association for Accessible Medicines and IQVIA. Since 2015, that total has reached $56.2 billion. But the real story is in the big-ticket drugs.

Take Humira (adalimumab). For years, it was the top-selling drug in the world, costing over $70,000 per patient annually. When the first biosimilars launched in January 2023, list prices dropped by up to 85%. That’s not a small discount - it’s a seismic shift. But here’s the catch: the actual price patients pay isn’t always that low. That’s because drug pricing in the U.S. is a maze of list prices, rebates, and negotiated discounts. The manufacturer of Humira still offers big rebates to pharmacy benefit managers (PBMs), which can make the net price competitive with biosimilars - even if the list price is higher.

For Stelara (ustekinumab), the situation is clearer. Nine biosimilars entered the market by July 2025, with list prices as much as 90% below the original. In Medicare Part B, prices for both the originator and biosimilars have steadily dropped after each new entrant. The more biosimilars that come in, the harder manufacturers have to push to keep their prices high.

Why Don’t Biosimilars Save More?

If biosimilars are cheaper and just as safe, why do originator biologics still control 98.9% of biologic spending in 2023? The answer isn’t about science - it’s about money and market structure.

First, there’s the rebate trap. Originator companies pay huge rebates to PBMs and insurers to keep their drugs on formularies. These rebates are hidden from patients and even doctors. So even if a biosimilar’s list price is 30% lower, the net price after rebates might be nearly the same. That makes it hard for plans to justify switching.

Second, there’s inertia. Doctors are trained to prescribe what they know. Patients are told, "This is the one that works." Many don’t know biosimilars exist - or think they’re "second-rate." A 2025 survey by CSRxP found that 42% of patients were unsure if biosimilars were as safe as the original. Education is still lagging.

Third, the U.S. has a massive "biosimilar void." Out of the 118 biologics expected to lose patent protection in the next 10 years, only 12 have biosimilars in development. That means 90% of future biologic spending could remain locked into high-priced originators. In the EU, 73% of high-sales biologics have biosimilars in the pipeline. In the U.S., it’s 23%.

Real-World Savings: Patients, Employers, and Systems

The savings aren’t just numbers on a balance sheet. They’re real for people.

- Patients: In commercial insurance markets, out-of-pocket costs for biosimilars are 23% lower than for originators. For some, that means dropping from $1,200 a month to $920 - a difference that can make or break whether someone fills their prescription.

- Employers: A single employer switching all employees from Humira to a biosimilar can save an average of $1.53 million per year. Across all self-insured U.S. companies, switching just two biologics to biosimilars could save $1.4 billion annually.

- Healthcare systems: Every dollar saved on biologics is a dollar that can go toward cancer drugs, mental health services, or diabetes care. Studies show that after biosimilars enter the market, countries reinvest savings into other high-cost therapies. In Norway, biosimilars captured 86% of the market for certain biologics within three years. The U.S. is nowhere near that.

How to Get More Savings - and Why It’s Not Happening Faster

The tools to unlock more savings exist. Employers and health plans can:

• Make biosimilars the first-line option on their formularies
• Require patients to try a biosimilar before approving the originator (step therapy)
• Negotiate contracts that reward biosimilar use, not rebates
• Train doctors and educate patients on biosimilar safety and efficacy

But most plans don’t. Why? Because it’s complicated. PBMs often push back. Manufacturers fight hard to protect their revenue. And without strong policy pressure, there’s little incentive to change.

The Inflation Reduction Act of 2022 gave Medicare Part D new tools to negotiate drug prices, but it doesn’t directly target biosimilars. The FDA has made steps to speed up approvals, but the pipeline is still dangerously thin. Without federal action to require transparency in rebates, or to fund biosimilar development for high-need drugs, savings will remain stuck.

The Big Picture: Biosimilars Are a Tool - Not a Magic Bullet

Biosimilars are one of the most promising tools we have to control the cost of modern medicine. They’re not generics. They’re not perfect. But they’re safe, effective, and dramatically cheaper than the originals - when they’re allowed to compete.

The $234 billion in potential savings over the next decade isn’t a guess. It’s a calculation based on what’s already happened with Humira, Stelara, and others. The problem isn’t the science. It’s the system. Until we fix the rebate system, stop letting manufacturers block competition, and invest in building a stronger biosimilar pipeline, those savings will stay out of reach.

The next time you hear about a new biologic costing $100,000 a year, ask: Is there a biosimilar? If not, why not? Because the answer might be the difference between someone getting treatment - or not.