Biosimilar Pricing Strategies: Understanding High-WAC and Low-WAC Models

EP: 1.Clinical Value of Biosimilars and the Role of Interchangeability

EP: 2.The Economic Impact of Biosimilars

EP: 3.Best Practices for Employers to Maximize Uptake of Biosimilars

EP: 4.The Role of Private Label Agreements in Enhancing Access to Biosimilars

EP: 5.Key Structural and Operational Considerations for Biosimilar Adoption

EP: 6.Positioning Biosimilars in Clinical Practice

EP: 7.Assessing Patient Confidence With Biosimilars

EP: 8.The Role of Different Stakeholders in Optimizing the Uptake of Biosimilars

EP: 9.The Growing Market for Biosimilars

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EP: 10.Biosimilar Pricing Strategies: Understanding High-WAC and Low-WAC Models

Biosimilars Pricing Strategies and Private Label Agreements: A Summary for Physicians

Dual Pricing Strategies for Biosimilars

Manufacturers of biosimilars often offer both high-WAC and low-WAC versions of their products for several strategic reasons, including the following:

• To navigate the complex reimbursement landscape across different payer segments
• To balance market access with revenue optimization
• To compete effectively with reference biologics in both hospital and outpatient settings
• To address varying formulary placement requirements across health care systems

Institutional Experience With Low-WAC Biosimilars

Health care institutions implementing low-WAC biosimilars on formulary have observed the following:

• Significant cost savings that can be redirected to other aspects of patient care
• Improved patient access through reduced out-of-pocket expenses
• Simplified reimbursement processes in certain settings
• Potential challenges with payer preferences that may not align with the lowest-cost options

Private Label Agreements: Definition and Benefits

Private label agreements are specialized contractual arrangements in which:

• A biosimilar manufacturer partners with a specific payer or PBM
• The biosimilar is marketed under a unique national drug code specific to that partnership
• Preferential pricing and access terms are established for specific patient populations
• These arrangements improve biosimilar access by creating tailored solutions for different insurance types and patient demographics

PBM Implementation of Private Label Agreements

PBMs are increasingly utilizing private label agreements for biosimilars due to the following:

• The ability to negotiate more competitive pricing terms
• Enhanced formulary control and consistency
• Improved predictability in medication spending
• Potential for developing integrated care models that include biosimilars
• Opportunities to create value-based arrangements tied to patient outcomes