What to Know
- Biosimilars are expanding across rheumatology, gastroenterology, neurology, and allergy/immunology, reshaping specialty drug economics.
- Step therapy, site-of-care steering, and formulary exclusions are accelerating biosimilar uptake in 2026.
- Practices must anticipate Average Sales Price (ASP) variability, reimbursement shifts, and patient transition workflows.
- Consolidation among PBMs, payers, and wholesalers is increasing complexity in access and contracting.
- Remedy GPO helps practices protect autonomy, purchasing power, and financial predictability.
Why 2026 Is a Turning Point
Biosimilars are entering a new phase of maturity. Multiple autoimmune, GI, neurology, and immunology agents are expected to reach broader adoption in 2026 as new products launch and payers intensify their shift toward lower-cost options.
For buy-and-bill practices, biosimilars now influence acquisition cost, reimbursement strategy, and patient continuity of care.
Understanding these market forces, especially payer behavior, is essential for maintaining operational and financial stability.
The 2026 Biosimilar Market Landscape
Across autoimmune and inflammatory diseases, biosimilars have moved from early adoption to full competitive pressure.
Analysts expect continued expansion of biosimilar pipelines targeting TNF inhibitors, integrin inhibitors, IL-6 blockers, JAK-adjacent biologics, and neuro-immunology therapies.
Three trends define 2026:
1. Accelerating Market-Access Consolidation
The AMA’s Policy Research Perspectives report shows that a small number of vertically integrated insurer–PBM entities now manage the majority of covered lives in the United States. This gives them increasing control over formularies, rebate flows, and channel access.
For specialty practices, this consolidation raises the likelihood of payer-mandated biosimilar transitions, formulary exclusions, and restricted distribution networks, directly affecting buy-and-bill economics and patient continuity.
2. Increased Pricing Compression
As more biosimilars enter the same molecule class, competitive bidding and payer contracting drive down net pricing. Meaning specialty practices should expect more frequent ASP fluctuations and tighter margins.
3. Site-of-Care Dynamics Intensify
Payers may increasingly incentivize lower-cost physician offices, while also steering biosimilar administration to preferred sites. These shifting dynamics make 2026 a critical year for practices to refine forecasting, contracting, and operational planning.
How Payer Policies Are Shifting
Several policy changes in 2026 will affect coverage and reimbursement predictability:
Step-Therapy and Fail-First Requirements
Payers increasingly require patients to try a biosimilar before a reference biologic, even without FDA-designated “interchangeability.”
Interchangeability vs. Payer Substitution
While FDA interchangeability remains a regulatory designation, many payers implement their own substitution rules that prioritize lower-cost biosimilars.
Accumulator and Maximizer Programs
These programs may limit manufacturer assistance for biologics, further pushing patients toward payer-preferred biosimilars.
Reimbursement Variability
During biosimilar rollout, ASPs may shift significantly quarter to quarter. To manage these variabilities, practices must actively monitor:
- ASP trends
- HCPCS code changes
- Transitional pass-through policies
- Infusion administration reimbursement
Without proactive visibility, revenue leakage becomes likely.
Strategies for Specialty Practices in 2026
To maintain both clinical and financial stability, practices should implement the following:
1. Strengthen ASP and Acquisition-Cost Forecasting
Track quarterly ASP updates, payer contracting shifts, and potential margin compression.
2. Standardize Patient Transition Workflows
Develop consistent communication explaining:
- Why the transition is occurring
- Biosimilar efficacy and safety
- What patients should expect
Clear communication reduces fear, confusion, and nonadherence.
3. Identify Revenue-Risk Points
Focus on:
- Coding accuracy
- Eligibility and benefits verification
- Payer mix changes
- Correct HCPCS billing for each biosimilar
4. Leverage GPO Partnership for Stability
A strong GPO partnership, such as the support provided by Remedy GPO, helps practices:
- Maintain purchasing power
- Access transparent contracting
- Gain real-time market intelligence
- Navigate reimbursement variability
- Protect practice autonomy in a consolidated market
How Remedy GPO Helps Practices Stay Ahead
Remedy GPO provides:
- Transparent, competitive contracts
- Data-driven market intelligence on biosimilar pricing and payer policies
- Strategic guidance to protect buy-and-bill economics
- Tools that support practice autonomy, financial predictability, and patient access
This advisory support enables practices to respond quickly to payer and market-access changes.
FAQ
1. Are biosimilars truly interchangeable with reference biologics?
FDA “interchangeability” is a regulatory designation, but many payers mandate biosimilar use regardless.
2. What reimbursement changes should practices expect in 2026?
Greater ASP variability, HCPCS updates, and payer-driven formulary adjustments.
3. How will biosimilars affect practice profitability?
Lower acquisition costs can improve margins, but only if ASP trends and payer reimbursement are actively monitored.
4. How does Remedy GPO support biosimilar adoption?
Through transparent contracting, pricing insights, reimbursement strategy support, and ongoing market intelligence.
