Biosimilar Access Gaps in 2026
Biosimilar Access Gaps in 2026
Biosimilars Are Saving Billions. Many Patients Still Cannot Access Them. Here Is the Full Picture.
5 minute read
The biosimilar market in the United States has grown faster in the last three years than in the prior decade combined. Dozens of biosimilars are now available for drugs that once had no competition, and the savings at the system level are substantial. But Cardinal Health's 2026 Biosimilars Report offers a more complicated picture for patients on the ground: adoption is accelerating, but access gaps are real, persistent, and unevenly distributed.¹ If you are a patient trying to access a biosimilar or navigate a biosimilar transition, understanding where the system actually stands helps you anticipate the barriers you might encounter.
The State of Biosimilar Adoption in 2026
The biosimilar market in the U.S. crossed significant adoption thresholds in 2025 and 2026. Adalimumab (reference product: Humira) now has more than 20 FDA-approved biosimilar versions, and combined biosimilar market share has reached substantial levels in the commercial and Medicare markets.¹ Rituximab biosimilars (reference: Rituxan), bevacizumab biosimilars (reference: Avastin), and trastuzumab biosimilars (reference: Herceptin) have also seen meaningful adoption across oncology practices.
Cardinal Health's report identifies several categories of biosimilars that are now widely available and achieving strong market penetration. These include adalimumab biosimilars, filgrastim biosimilars (reference: Neupogen), infliximab biosimilars (reference: Remicade), and pegfilgrastim biosimilars (reference: Neulasta). In these categories, the shift from originator to biosimilar is largely complete or well underway in most covered patient populations.¹
The savings are meaningful. Biosimilars typically enter the market at 15 to 35 percent below the reference biologic's list price, and net prices after rebates can be lower still.¹ For patients, the savings should theoretically translate into lower cost-sharing. In practice, whether they do depends heavily on how your specific plan has structured its benefit around the biosimilar.
Where the Access Gaps Are
Cardinal Health's report identifies several areas where patient access to biosimilars remains inconsistent despite their availability.
Specialty distribution requirements are one barrier. Some biosimilars, particularly in oncology and rare disease categories, require distribution through specific specialty pharmacy or limited distribution networks. If your insurer requires you to obtain a biosimilar through a specific pharmacy and that pharmacy is not convenient or accessible to you, that is a practical access barrier even if the drug is technically covered.
Formulary complexity is another. Multiple adalimumab biosimilars exist, and different plans cover different products. One plan may cover Hadlima on a preferred tier while another covers Hyrimoz. If your physician writes a prescription that does not match what your plan covers, you may face a coverage issue that looks like a denial but is actually a formulary mismatch. The solution is usually a prescription rewrite to the covered biosimilar, but navigating that process takes time you may not have when you are due for a refill.
Provider adoption gaps also affect patient access in ways patients rarely see. Some providers, particularly in community settings, have been slower to adopt biosimilar prescribing because of administrative complexity, patient concerns, or lack of familiarity with the specific products. If your provider is still defaulting to the reference biologic and your plan no longer covers it at a reasonable tier, you end up caught between your prescriber's habits and your insurer's coverage structure.
Patients in underserved communities and rural areas face additional barriers related to specialty pharmacy access, limited provider familiarity with biosimilar products, and Medicaid coverage variability.¹
What the Savings Actually Look Like for Patients
System-level biosimilar savings are frequently cited in policy discussions, but the translation to patient cost-sharing is not automatic.
If your plan places a biosimilar on a preferred specialty tier and passes some of the rebate savings through as lower cost-sharing, you will see lower out-of-pocket costs compared to the reference biologic. Some plans have structured biosimilar cost-sharing to be meaningfully lower than the reference product, which is the intended effect of formulary management.
But if your plan places the biosimilar on the same specialty tier as the reference biologic without adjusting cost-sharing, you may not see any savings at all. And if your plan has moved to a high-deductible design, you may be paying the full cost of the biosimilar until you meet your deductible, which can still be a significant sum.
Cardinal Health's report notes that patient cost-sharing structures for biosimilars vary widely across plans, and that patients who are not seeing savings should check whether their plan's tier structure for biosimilars is designed to pass savings through.¹
What This Means for You
If you are currently taking a biologic medication and have been asked to switch to a biosimilar, or if you are starting a biologic therapy and want to understand your options, these are practical steps.
Ask your insurer specifically which biosimilar products are covered on which tier for your medication. Do not assume the biosimilar is automatically cheaper for you. Ask for the specific tier placement and estimated cost-sharing.
If you are being asked to use a specific biosimilar through a specific pharmacy and that creates a logistical barrier, ask your insurer whether alternative dispensing options are available or whether a medical hardship exception exists.
If you are on a reference biologic and your plan is moving to biosimilar coverage, ask your physician to review the covered biosimilar options before the transition. Biosimilars are not interchangeable with each other, only with the reference product. Your physician should be involved in the decision.
If you receive a denial related to a biosimilar access issue, whether because you were denied the specific biosimilar your plan covers or because you are seeking the reference biologic, the appeals process is available to you.
Ellen can help you understand your denial and build your appeal. Start here
Frequently Asked Questions
Are all adalimumab biosimilars the same?
All FDA-approved adalimumab biosimilars have been shown to have no clinically meaningful differences from the reference product Humira in terms of safety, purity, and potency. However, they are manufactured by different companies, may come in different concentrations or formulations (for example, citrate-free vs. citrate-containing, auto-injector vs. prefilled syringe), and your insurer may only cover specific products. One biosimilar cannot be automatically substituted for a different biosimilar at the pharmacy.
My plan covers a biosimilar but my doctor wants me on the reference biologic. What can I do?
If your physician has a clinical reason for the reference biologic, they can file a medical exception request with your plan. The request should document why the reference product is medically necessary for your individual situation. Common reasons include documented adverse reactions to the covered biosimilar, specific formulation requirements, or documented therapeutic failure of the biosimilar alternative.
Will biosimilar prices go down further over time?
The biosimilar market in the U.S. is still maturing. In markets like Europe where biosimilars have been available longer, competition among multiple biosimilar entrants has driven prices down significantly over time. As more biosimilars enter categories like adalimumab and ustekinumab, additional price competition is expected, though the complex rebate structures in the U.S. market mean the savings do not always flow directly to patients.
Sources: