US Biosimilar Payer Coverage Expands Rapidly
New data shows a major shift in health insurance policies prioritizing biosimilar drugs over originator biologics.
Updated on Oct. 28, 2026 in Healthcare
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Should insurance policies prioritize lower-cost biosimilars over originator biologics to improve patient health?
Recent findings presented at AMCP Nexus 2026 reveal that payer requirements for patients to fail on expensive originator biologics have plummeted. Today, the vast majority of insurance policies now designate biosimilars as the preferred product for treatment.
Why it matters
This shift is significantly lowering healthcare costs by ensuring patients gain faster access to more affordable biosimilar alternatives. Aligning insurance coverage with current clinical guidelines helps streamline treatment and reduces financial barriers for patients.
In 2025, 94% of payer policies listed biosimilars as the preferred product, compared to just 6% that still require patients to fail on an originator biologic. This marks a stark decline from 2017, when 55% of policies enforced failure on the originator.
The players
James Chambers
He is the researcher who presented the updated findings on biosimilar adoption trends at the AMCP Nexus 2026 meeting.
National Institute for Health and Care Excellence
This public body provides national guidance and advice to improve health and social care in the United Kingdom.
The details
Industry analysts note that biosimilars are successfully driving down the cost of biologic treatments. The National Institute for Health and Care Excellence in the United Kingdom similarly revised its stance on the drug bevacizumab only after a biosimilar became available in the market.
Timeline
In 2017, 55% of policies required failure of the originator product.
In 2025, only 6% of policies required failure of the originator product.
Data was presented at the AMCP Nexus 2026 conference in October 2026.
Market Landscape
The current expansion of U.S. biosimilar preference follows the pattern set by the National Institute for Health and Care Excellence bevacizumab decision, where market competition directly forces regulatory and payer policy shifts. This transition signals a broader industry move toward cost-effective alternatives.
Patients may find it significantly easier to access cost-effective biosimilar treatments without jumping through administrative hurdles like failing on expensive originator drugs first. These shifts in insurance coverage are designed to lower out-of-pocket costs and improve overall medication access.
The takeaway
The rapid move to prioritize biosimilars demonstrates how market competition effectively reshapes healthcare access. Patients should verify their specific plan coverage to see if biosimilar options are now preferred for their ongoing treatments.
Further reading
For more on evolving drug access, visit the United States Healthcare section.
Source note: This article includes information reported by Ajmc.
Live Poll
Should insurance policies prioritize lower-cost biosimilars over originator biologics to improve patient health?
