5 questions about the evolving biosimilar landscape

Tasmina Hydery: Our market access team has been conducting biosimilars research for at least the past five years. Cencora has invested in this area because biosimilars represent an opportunity to reduce healthcare costs and expand patient access to medications. With rapid growth in the biosimilars market and more products entering the pipeline, we wanted to better understand how payer perceptions and adoption strategies are evolving. Ultimately, we're interested in how biosimilars can create value across the healthcare system and help patients access the therapies they need. 

Dennis Nelson: Cencora occupies a unique position in the healthcare ecosystem. We have a responsibility not only to help bring these products to market, but also to support customers and patients in gaining access to them. Research like this helps us understand how access is changing and where opportunities exist to continue advocating for broader adoption.

Tasmina Hydery: Yes. We hypothesized that payer support for biosimilars would continue to increase over time. Biosimilars have been approved for more than a decade,¹ and we expected that growing experience would make organizations more comfortable adopting them. We also anticipated that demonstrated cost savings would contribute to continued uptake. The research supported both expectations, showing increased payer support and more proactive planning around biosimilar adoption.

Dennis Nelson: The findings also suggest that biosimilars have become an established part of the healthcare conversation. According to the payers represented in the research, the focus is increasingly on how to adopt and sustain biosimilars rather than whether they have a role to play in patient care. 

Tasmina Hydery: The strongest takeaway is that payer support for biosimilars continues to grow. In 2021, 67% of surveyed payers reported supporting biosimilar use. By 2026, that number had increased to 86%. We also found that organizations are planning for biosimilars much earlier than they were just a few years ago. In 2023, only 24% of surveyed payers reported reviewing biosimilars before FDA approval. By 2026, that figure rose to 65%. Organizations are definitely seeing the opportunities biosimilars present and are preparing for them much earlier in the process. 

Another important takeaway is what that means for manufacturers. As payers begin evaluating biosimilars earlier, biopharma companies need to start conversations with decision-makers sooner and ensure they have information to support those discussions. 

Shaila Yoshida: We also found that payer management strategies continue to support biosimilar adoption. Prior authorization remains common, increased use of formulary exclusions for reference products and step therapy requirements to encourage biosimilar uptake. We observed particularly rapid adoption of ustekinumab biosimilars: as of April 2026, 91% of payers in our study covered either biosimilars only (51%) or both the reference product and biosimilars (40%), despite their relatively recent market entry.  

Dennis Nelson: One theme that continues to emerge is the importance of education and advocacy. Biosimilars are becoming a more established part of healthcare, but stakeholders still need help understanding their options and how these products fit into treatment decisions. 

Shaila Yoshida: One surprising finding was how quickly ustekinumab biosimilars are achieving formulary adoption. Compared with earlier experiences, such as the Humira biosimilar launch, we are seeing signs that payers are applying lessons learned from previous launches and moving more quickly to incorporate newer biosimilars into coverage strategies. 

We also found that payer management strategies continue to support biosimilar adoption. Prior authorization remains common, while formulary exclusions of reference products and step therapy requirements are increasingly being used to encourage biosimilar utilization. Together, these findings suggest that payers are becoming increasingly comfortable with biosimilars and are applying lessons learned from earlier biosimilar launches to accelerate adoption. 

Tasmina Hydery: We also saw evidence of growing payer confidence in biosimilars. More than half of the payers we surveyed reported that they would cover biosimilars across indications held by the reference product, even when specific biosimilar labeling differed. We also found a positive response to the FDA's efforts to streamline biosimilar development, with nearly 80% of surveyed payers indicating those changes could increase confidence in biosimilars. 

Shaila Yoshida: The biosimilar landscape continues to evolve quickly, so we'll continue tracking how recently launched biosimilars perform over time. One area of interest is understanding how newer products compare with earlier biosimilar experiences and whether those adoption patterns continue to accelerate. We're also watching future pipeline opportunities and how payers prepare for major launches years before products reach the market. 

Dennis Nelson: We'll continue monitoring market developments and policy changes that could influence adoption. Just as importantly, education and advocacy remain needed to help stakeholders understand the value and role of biosimilars.

Tasmina Hydery: We've seen meaningful growth in payer support and preparedness over the past five years, but the market is still evolving. Continuing to monitor payer attitudes, coverage strategies, and adoption trends will help us understand what drives the next phase of biosimilar growth.