The Biosimilar Conversation Nobody Is Having at the Pharmacy Counter: Why Adoption Is Still Struggling and What We Can Do About It

A patient comes to my counter to pick up their adalimumab (Humira; AbbVie) refill, but they find that their plan has switched them to a biosimilar adalimumab-adaz, or adalimumab-afzb, or one of the 7 other versions now on the market. They have no idea this happened. They just know the name on the bag is different from what they have been injecting into their body for 3 years.

The following conversation, in which I explain what a biosimilar is, why it is safe, why their plan made this change, and why the medication in their hand will work the same as the one they have been on, takes about 10 minutes. And it is a conversation that most patients are not having anywhere else.

Here is the reality: more than 80 biosimilars have been approved by the FDA, yet broad adoption has not happened the way anyone predicted.¹ The savings are real—biosimilar utilization between 2020 and 2024 was projected to generate around $104 billion in cost savings—but the promise has not fully materialized.² The reason is not regulatory. It is not clinical. It is human. Patients and providers are hesitant, and that hesitancy lives in a gap that pharmacists are uniquely positioned to close.

What the Data Show

The biosimilar landscape is at what some in the industry are calling a critical inflection point entering 2026.¹ Adoption rates are sharply divided by disease area. Oncology biosimilars are seeing high uptake, which makes sense, because patients with cancer are often starting a new therapy and have no prior attachment to a reference product. But biosimilars for chronic immunology conditions like rheumatoid arthritis, psoriasis, and inflammatory bowel disease are seeing consistently slower uptake.¹

The reason is straightforward: if a patient has been stable on a reference biologic for years, the idea of switching feels like a risk, not an opportunity. That perception is clinically incorrect, but it is very real psychologically, and it is the pharmacist's job to address it.

Adding to the complexity, some states require pharmacists to notify prescribers before dispensing a biosimilar, creating an additional administrative step that can delay treatment and discourage substitution altogether.³ Others mandate additional documentation or patient consent, which increases workload and creates confusion among patients who are already uncertain about what a biosimilar is.³

What Is Actually True About Biosimilar Safety

This is the conversation that needs to happen at the counter, clearly and confidently. A biosimilar is not a generic. Generics are chemically identical copies of small-molecule drugs. Biosimilars are highly similar, not identical versions of complex biologic products made from living cells. The FDA's approval pathway requires that a biosimilar demonstrate no clinically meaningful differences in safety, purity, or potency compared to the reference product.⁴

Interchangeability is the concept that confuses most patients and providers. An interchangeable biosimilar has met an additional standard, demonstrating that it can be substituted at the pharmacy level without prescriber involvement, like a generic.⁵ As of 2026, the FDA has moved toward removing the separate interchangeability designation for most biosimilars, reflecting the robust safety data now available from real-world use.⁵

The clinical evidence supports this confidence. Findings from a systematic review published in Clinical Pharmacology and Therapeutics found no efficacy, safety, or immunogenicity issues in switching data across available biosimilars.⁴ Multiple studies across oncology, dermatology, and immunology have found the same thing. The science is clear. The communication gap is the problem.

What Pharmacists Can Do Right Now

The hesitancy gap is a counseling gap. Here is how to close it at the counter.

Lead with the why, not the what. Most patients do not need a detailed explanation of biologic manufacturing. They need to know why their plan made this change and what it means for them. Pharmacists can say, "Your insurance switched you to a version of this medication that works the same way, with same mechanism and same results, and costs your plan significantly less. Your dose and your schedule stay exactly the same." That is usually enough to start.

Acknowledge the anxiety directly. Patients who have been stable on a reference biologic for years are not being irrational when they express concern. Validate it. Tell them, "I understand this feels like a change, and it makes sense to want to make sure it will work the same way. Here is what the evidence shows." That acknowledgment matters before the clinical explanation lands.

Know your state's substitution laws. Some states allow automatic substitution of interchangeable biosimilars. Others require prescriber notification or patient consent. Know exactly what your state requires so you are not creating unnecessary delays or confusion. Patients who are told "I need to call your physician first" without explanation often assume something is wrong with the medication.

Address the needle question early. Many patients on self-administered biologics ask whether the injection device is the same. For some biosimilars it is, for others it is not. If the autoinjector or pen design has changed, spend 2 to 3 minutes on technique the same way you would with any new device. This single step prevents patient challenges that erode confidence in the biosimilar.

Proactively loop in the prescriber when needed. For patients with longstanding autoimmune conditions who are particularly anxious about switching, a quick note to the prescriber confirming the substitution and documenting that counseling occurred protects the patient and builds the kind of collaboration that makes future substitutions easier.

The Bigger Picture

The biologics market is projected to grow from $450 billion to nearly $850 billion over the next decade.⁶ Biosimilars are the single most powerful tool available to slow that cost trajectory without compromising patient outcomes. But the savings only materialize when patients fill the biosimilar and, right now, too many are not.

Pharmacists are the most accessible point in the system for this conversation. We are the ones patients call when the bag looks different. We are the ones who get the question, "Is this the same as what I was taking?" We are the ones who can turn that moment of confusion into a moment of confidence. The biosimilar conversation nobody is having is the one that needs to start at our counter.

REFERENCES

1. Becker Z. As biosim industry confronts looming ‘void,’ 2026 marks a chance to take stock and embrace changing landscape. Fierce Pharma. January 8, 2026. Accessed June 23, 2026. https://www.fiercepharma.com/pharma/us-biosimilar-landscape-marked-too-many-question-marks-shifting-policy-complex-market

2. Shah S, Patel P. Biosimilar adoption: patient and provider considerations. Pharmacy Times. July 25, 2022. Accessed June 23, 2026. https://www.pharmacytimes.com/view/biosimilar-adoption-patient-and-provider-considerations

3. Biosimilar adoption: why low uptake is still a challenge. SmithRx. July 15, 2025. Accessed June 23, 2026. https://smithrx.com/blog/biosimilar-adoption-why-low-uptake-is-still-a-challenge

4. Meara K. Pharmacist education, knowledge key to fostering biosimilar adoption. Drug Topics. March 19, 2024. Accessed June 23, 2026. https://www.drugtopics.com/view/pharmacist-education-knowledge-key-to-fostering-biosimilar-adoption

5. Rome BN, Bhaskar A, Kesselheim AS. Biosimilar interchangeability and substitution in the US: what comes next? Am J Manag Care. 2026;32(4):198-201.

6. Smith S. Exploring the future of biosimilars: market insights. National Insurance Services. May 12, 2025. Accessed June 23, 2026. https://blog.nisbenefits.com/future-of-biosimilars-market-insights