艾昆纬-美国医疗福利生物仿制药报销建模政策建议.pdfVIP

ModelingPolicyProposals

forMedicalBeneit

BiosimilarReimbursement

intheU.S.

Ananalysisofaveragesalespriceand

providernetcostrecoverydynamics

FEBRUARY

2026

Introduction

SpendingonbiologicmedicinesintheUnitedStateshasincreasedrapidlyin

recentyears,reaching$262Bnin2024andaccountingformorethanhalfoftotal

medicinespending.Asmanyhigh-costbiologicsfacepatentexpiry,biosimilars

havethepotentialtocontinueintroducingcompetitionandgenerating

meaningfulsavingsforthehealthcaresystemwhilemaintainingclinical

outcomes.However,theeconomicandpolicyenvironmentgoverningbiosimilars

reimbursedunderthemedicalbeneitpresentsadistinctandincreasingly

complexsetofchallengesthatmaylimittheirlong-termsustainability.Ifleft

unaddressed,theseissuescouldleadtoreducedinvestmentinfuturebiosimilar

development,biosimilarmarketexits,diminishedhealthcaresystemsavings,

andfewertreatmentchoicesforpatientsandproviders.

Thisreportevaluatesivepolicyproposalsintendednear-termsavingswiththelong-termsustainability

toaddressthesechallengesbymodifyingASP-basedofthebiosimilarmarketandtheincentivesneededto

reimbursementformedicalbeneitbiosimilars.supportcontinueddevelopmentandadoption.

TheseincludesmoothingASPcalculationsovermultiple

quarterstoreducevolatility,extendingtheinitialperiodofThisstudywasproducedindependentlybytheIQVIA

WholesaleAcquisitionCost(WAC)basedreimbursementInstituteforHumanDataScienceandtheIQVIAU.S.

followingbiosimilarlaunch,increasingadd-onpaymentsMarketAccessStrategyConsultingteam.TheBiosimilars

forbiosimilarreimbursements,establishingminimumForumprovidedfundingandconsultedonthisresearch

AS