Biosimilars in Practice: Advancing High-Quality, Affordable Care for Kansans

Biosimilar medications are increasingly reshaping the specialty drug landscape, offering clinically comparable alternatives to reference biologics at a lower cost. For medical providers, understanding a health plan’s biosimilar strategy is no longer optional; it directly affects prescribing workflows, patient affordability, Site of Care decisions and long-term sustainability of biologic therapies. As the specialty drug pipeline continues to expand, thoughtful biosimilar adoption supports sustainability for patients, providers and the health care system as a whole.

BCBSKS biosimilar strategy

Specialty biologics represent a significant and growing share of total drug spend. Brand name medication prices, in general, have increased at twice the rate of inflation in the last 20 years. These rising costs contribute to higher premiums for members. The biosimilar strategy at Blue Cross and Blue Shield of Kansas (BCBSKS) is designed to balance continued access to innovative therapies while maintaining responsible stewardship of premium dollars on behalf of members and employer groups. These decisions undergo extensive review by our staff of clinical pharmacists and doctors.

Key objectives of biosimilar strategy include:

• Promoting affordable access to essential biologic therapies
• Supporting the long-term sustainability of pharmacy and medical benefits
• Reducing unnecessary cost variation while maintaining quality outcomes
• Aligning coverage with evidence-based clinical practice

Why it matters for medical providers

1. Formulary and coverage alignment

   BCBSKS has designated biosimilar products as preferred for several specific reference products. The chart reflects the reference products and subsequent preferred biosimilars for each line of Medicare and Commercial business:

Providers are encouraged to review BCBSKS formularies and medical policies to ensure efficient prescribing. Formulary exceptions will be required for members to remain on reference products but, depending on benefits, these may not be available for all members.

2. Treatment initiation and ongoing therapy
   BCBSKS prioritizes biosimilars for both new treatment initiation and for existing treatment. Clinical decision making remains central to all treatment decisions, and BCBSKS will work to support continuity of care through:
   • Proactive biosimilar authorizations for members currently on reference products affected by biosimilar strategy changes
   • Clear coverage policies
   • Provider and patient education materials
3. Practice operations and reimbursement
   BCBSKS recognizes that buying and billing biosimilars can affect practice workflows, inventory management and reimbursement, resulting in operational adjustments. Commitment to biosimilars can also:
   • Reduce coverage variability
   • Improve payment predictability
   • Support long-term access to biologic therapies
     While some practices initially experience operational adjustments, many find that predictable pricing and broader coverage reduce payment disputes and improve long-term revenue stability.
4. Supporting patient confidence
   Patients may have questions when starting or transitioning to a biosimilar. Provider reassurance is essential. Members should contact their doctor to discuss switching to a biosimilar if they want to continue on a covered medication. Members with questions can also call customer service at the number on the back of their card. Consistent education helps build trust and supports adherence.
   The key messages that should be communicated from providers include:
   • Biosimilars meet FDA standards for safety and effectiveness
   • Clinical outcomes are highly similar to reference products
   • Lower costs can improve long-term treatment access

The biosimilar pipeline continues to expand across immunology, oncology and rare disease therapies, signaling a long-term shift in how biologics are delivered and financed. For providers, biosimilars represent a strategic tool to sustain access to innovative treatments for the patients who need them most. Alignment between providers and BCBSKS minimizes administrative disruption and facilitates smoother adoption for the future.