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Getting the latest healthcare news for you
Getting the latest healthcare news for you
Despite big price differences between ustekinumab (Stelara) and its biosimilars, Medicare Part D patients are paying nearly the same out-of-pocket costs across all versions. A new study found that most plans cap patient costs around the $2,100 Part D limit regardless of the drug's gross price. The system offers patients little financial incentive to choose cheaper biosimilar options.
Biosimilars were supposed to bring down drug costs, but for Medicare Part D patients on ustekinumab (Stelara), the savings aren't reaching their wallets. A new cross-sectional study published in JAMA Network Open analyzed 3,345 Medicare Part D plans covering more than 39 million enrollees and found that patients pay roughly the same out-of-pocket costs whether they're on the brand-name drug or a biosimilar — often hitting the $2,100 annual cap.
The culprit? Nearly all plans (99.2%) use coinsurance rather than flat copays, meaning patient costs are tied to the drug's gross price. And while gross annual spending per patient varied widely across products, that difference is largely absorbed by plans, manufacturers, and Medicare — not passed on to patients as savings.
By the Numbers:
Why it matters: When patients have no financial reason to choose lower-cost biosimilars, the potential savings from biosimilar competition never materialize. Researchers urge plans to prioritize coverage of low gross-cost biosimilars that actually translate to lower out-of-pocket costs for beneficiaries.
