As drug pricing pressure intensifies and benefit structures shift, some health systems are still treating biosimilars as a selective cost lever — deploying them in certain payer segments while preserving legacy models elsewhere.
Geisinger made a different call.
Rather than adopting biosimilars incrementally, the Danville, Pa.-based health system moved to a biosimilar-first strategy across all lines of business, spanning Medicare, Medicaid, and commercial and ACA plans. The goal, according to Michael Evans, Geisinger’s chief pharmacy officer, was to create a consistent, systemwide approach to affordability, as policy and reimbursement dynamics continue to evolve.
From selective to systemwide adoption
Geisinger’s shift accelerated in 2025, a year Mr. Evans described as increasingly complex for pharmacy leaders — particularly for organizations that operate as both payer and provider.
The Inflation Reduction Act reshaped managed care risk, especially within Medicare populations, forcing pharmacy teams to reassess formularies, tiering and cost exposure. Against that backdrop, biosimilars emerged as a more durable solution than incremental adjustments, Evans said.
Instead of limiting biosimilar adoption to specific products or payer groups, Geisinger standardized its approach.
“We set ourselves up to be biosimilar-first and independent of our line of business,” Mr. Evans said on a recent episode of the Becker’s Pharmacy Leadership Podcast. “Whether it be Medicare, Medicaid, commercial, TPA or ACA — we transitioned all of our patients for any of the available biosimilars.”
The result was broad uptake across multiple therapeutic areas. More than 90% of Geisinger members were transitioned to biosimilar versions of certain high-cost biologics, including treatments for inflammatory diseases and ophthalmologic conditions, Mr. Evans said.
Clinical efficacy remained the threshold. Geisinger evaluated biosimilars based on safety and effectiveness first, ensuring patients were not exposed to harm before making the shift.
Affordability as the primary driver
For Geisinger, the biosimilar-first decision was less about market positioning and more about affordability — particularly for Medicare members facing growing cost-sharing responsibilities.
By narrowing the price gap between reference biologics and lower-cost alternatives, pharmacy leaders aimed to reduce out-of-pocket costs while preserving access to therapy across the system’s footprint in northeastern and central Pennsylvania.
That consistency also simplified operations. Rather than maintaining parallel formularies and workflows by payer type, pharmacy teams could align education, prescribing and dispensing around a single default approach.
While IRA-driven pricing reform helped accelerate Geisinger’s shift, Mr. Evans emphasized that the biosimilar-first model is designed to outlast any single policy cycle.
Looking ahead to 2026, pharmacy leaders are preparing for continued uncertainty, including negotiated government pricing for the first 10 drugs under the IRA and unresolved questions around the future of the 340B rebate model.
In that environment, Mr. Evans said, pharmacy strategies that rely on narrow optimization are increasingly fragile. Systemwide alignment offers greater resilience as external conditions change.
Preparing for the next wave of high-cost therapies
Geisinger’s biosimilar strategy also reflects a longer-term view of where pharmacy complexity is heading.
As care continues to shift from small-molecule drugs to cell and gene therapies — many costing hundreds of thousands to millions of dollars per administration — the margin for inefficiency narrows. For integrated delivery networks, Mr. Evans said, managing pharmaceutical spend will require both clinical discipline and operational rigor.
Biosimilars, while not applicable to every future therapy, help create financial headroom as those ultrahigh-cost treatments become more common.
At the same time, Mr. Evans acknowledged that innovation introduces difficult decisions. In some cases, patients may seek advanced therapies that are not clinically appropriate for their specific disease variation or genetic profile.
“The hardest decision is going to be saying no to someone when we know the therapy is life-saving,” Mr. Evans said. “But their genetic mutation or variation of disease is beyond where we see efficacy.”
What the shift signals for pharmacy leadership
Geisinger’s move highlights a broader shift in pharmacy leadership thinking: away from siloed optimization and toward enterprisewide consistency.
Executing a biosimilar-first model requires coordination across managed care, ambulatory, hospital and specialty pharmacy teams — as well as alignment between clinicians and payers. Mr. Evans credited Geisinger’s enterprise pharmacy leadership structure with enabling that coordination at scale.
For other health systems, the takeaway is not simply to adopt biosimilars, but to reconsider how fragmented pharmacy strategies may limit impact.
As drug pricing reform, reimbursement pressure and advanced therapies converge, Mr. Evans suggested that pharmacy leaders who move early to standardize and simplify may be better positioned for what comes next.
