TIER 2 · BIOSIMILARS · READINESS ASSESSMENT
The Biosimilar Savings Are Real. Most Plans Miss Them.
The Six-Factor Biosimilar Readiness Assessment.
A 2-page printable scorecard PBS uses across 100s of PBM contract reviews annually. Free download. Sent to your inbox.
Six-factor Strong/Moderate/Weak biosimilar readiness rubric
Formulary placement, interchangeability, and incentive alignment
Where the PBM's rebate on the reference brand blocks the switch
Readiness gaps mapped to fixes
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A complete audit framework you can run in half a day.
WHAT IS IN THE WORKSHEET
PASS 03
Map Gaps to Fixes
The most common reason a plan misses biosimilar savings: the PBM earns a larger rebate on the high-priced reference brand, so its formulary quietly keeps the brand preferred over cheaper biosimilars.
PASS 01
Score Six Factors
Assess your plan's biosimilar readiness across six factors using a Strong / Moderate / Weak rubric: formulary placement, interchangeability handling, provider adoption, member incentives, and rebate-conflict exposure.
PASS 02
Find the Rebate Conflict
The most common reason a plan misses biosimilar savings: the PBM earns a larger rebate on the high-priced reference brand, so its formulary quietly keeps the brand preferred over cheaper biosimilars.
ACTION PLAN
This Quarter's Action Plan
Score the six factors, flag the Weak ones, and require your PBM to show biosimilar uptake and the rebate differential on the reference brand. The savings are there; readiness is what captures them.