How Biosimilars Could Lower Part D Costs for Seniors

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With Medicare open enrollment running through December 7 and the Part D annual out-of-pocket cap rising from $2,100 in 2026 to $2,400 in 2027, seniors and Part D plans are looking for ways to rein in drug costs.¹ Biosimilars could be one of them, but beneficiaries still face barriers to accessing these lower-cost products.

Understanding why seniors are not accessing biosimilars is the first step, Juliana Reed, MS, executive director of the Biosimilars Forum, said in an interview with The Center for Biosimilars^®.

"Biosimilars can increase the cost savings and increase the access for seniors," she said.

In both Medicare Part D and Part B, Reed said, reference products outnumber biosimilars in what is offered to beneficiaries by a 2:1 ratio.

"So for every 2 brand drugs, there's 1 biosimilar," she said. PBMs, plans, and CMS are using more reference biologics than biosimilars, she added.

That imbalance persists even as biosimilars launch at steep discounts. Biosimilars referencing Stelara (ustekinumab), for example, launched at discounts of 80% to 90%.² With premiums going up and affordability of health care decreasing for patients and families, Reed said, those savings matter.

"Here we have this incredible biosimilar product that is, again, highly discounted," she said. "But Medicare, especially CMS, is not giving it access."

Reed said CMS has long declined to interfere with PBMs' formulary decisions. She also pointed to Medicare Part B payment rules based on average sales price (ASP), which she said were written before PBMs operated the way they do today.

"Medicare has an opportunity to lower the cost for biologics and for the Medicare beneficiaries who need biologics. But they're not taking any steps forward to make that happen," Reed said.

Changing that will take action from Congress and the administration, she said.

"It's time. There's a lot of us baby boomers going into Medicare, and you don't want to pay for us, and you shouldn't," Reed said. "So, we need to change this."

References

1. CMS hikes Medicare Advantage rate 2.48% for 2027: 6 notes. Becker's Hospital Review. April 2026. Accessed November 6, 2026. https://www.beckershospitalreview.com/finance/cms-hikes-medicare-advantage-rate-2-48-for-2027-6-notes/

2. McCrear S, Reed JM. How the Biosimilars Access and Affordability Act redefines IRA delays. CFB. November 3, 2026. Accessed November 6, 2026. https://www.centerforbiosimilars.com/view/how-the-biosimilars-access-and-affordability-act-redefines-ira-delays