When a patient walks into the pharmacy with a prescription for a biologic drug like Neulasta or Humira, they’re not just getting a pill-they’re getting a complex therapy that can cost thousands per dose. That’s where the pharmacist steps in. Not as a silent filler of prescriptions, but as a key player in deciding whether a biosimilar can safely replace the original. This isn’t like swapping one generic pill for another. Biosimilars are different. And pharmacists are the ones who must explain why.
What Makes a Biosimilar Different from a Generic?
Most people think all cheaper versions of brand-name drugs are the same. They’re not. A generic drug, like simvastatin instead of Zocor, is chemically identical to the original. Same molecules. Same structure. Same everything. That’s why pharmacists can swap them automatically under state laws-97% of the time, they do.
Biosimilars? They’re not identical. They’re made from living cells, not chemicals. Think insulin, not aspirin. Because of this, even tiny differences in manufacturing-like temperature changes during production-can lead to minor structural variations. The FDA doesn’t require them to be exact copies. Instead, they must show no clinically meaningful differences in safety, purity, or how well they work. That’s a big deal. It means the patient won’t get worse outcomes. But it also means the pharmacist can’t just assume it’s a drop-in replacement.
Interchangeable vs. Non-Interchangeable: The Legal Line
Not all biosimilars are created equal under the law. Some are labeled “interchangeable.” That’s a special FDA designation. It means the pharmacist can swap it for the brand-name drug without checking with the doctor first. Think of it like a green light. As of late 2023, only a handful of biosimilars have this status. Most don’t. And that changes everything.
If a biosimilar isn’t interchangeable, the pharmacist can’t substitute it unless the prescriber allows it. That means either the doctor wrote “dispense as written” on the prescription-or the pharmacy has to call them for permission. That slows things down. It adds work. It costs time. And in busy clinics, that’s a problem.
But here’s the twist: even when substitution isn’t automatic, pharmacists still play a huge role. They’re often the first to spot that a biosimilar is cheaper, more available, or better suited for the patient. They can suggest it. They can explain it. And in many cases, they’re the ones who convince the doctor to allow the switch.
Why Pharmacists Are Leading the Charge
Studies show pharmacists are far more likely than doctors to recommend biosimilars. One 2022 survey found that 87% of pharmacists said they’d recommend a biosimilar to a patient, compared to just 62% of physicians. Why? Because pharmacists spend more time learning about them. Nearly 80% of pharmacists have taken continuing education on biosimilars. Only 43% of doctors have.
At the US Oncology Network, they didn’t wait for doctors to catch up. They trained everyone-pharmacists, nurses, financial navigators, even the prior authorization team. They made it mandatory. They used e-learning modules. They had every provider sign an acknowledgment form agreeing to automatic substitution policies. Within a year, biosimilar adoption for pegfilgrastim jumped dramatically. Why? Because the pharmacy team took over the substitution process. Doctors didn’t have to stop what they were doing to approve each switch. Patients got the right drug faster. And the system saved money.
How Pharmacists Counsel Patients-Without Scaring Them
Patients hear “biosimilar” and think “cheap knockoff.” That’s natural. But it’s wrong. One pharmacist in Manchester shared a story: a patient with rheumatoid arthritis refused to switch from Humira to its biosimilar. She was terrified. “It’s not the real thing,” she said. The pharmacist didn’t argue. He didn’t lecture. He showed her the FDA’s website. He explained the 10-year clinical trial data. He said, “The FDA says it works just like the original. No meaningful difference. And it’s been used safely by thousands.” She switched. And she’s been stable for 18 months now.
That’s the power of good counseling. It’s not about pushing a cheaper drug. It’s about correcting myths. Patients think switching biologics is risky. But research shows that repeated switching between a biosimilar and its reference product doesn’t increase side effects. The FDA, the EMA, and major medical societies all agree. The fear is real. The risk? Not so much.
But there’s a catch. Appearance matters. If a patient has been on a brand-name biologic for years, and suddenly the pill or injection device looks different-different color, different size, different label-they’re 21% more likely to stop taking it altogether. That’s why pharmacists need to prepare patients ahead of time. Not just say, “Here’s your new drug.” But say, “This is the same treatment, just made by a different company. The device might feel a little different, but it works exactly the same.”
Traceability and Tracking: The Silent Backbone
When a biosimilar is dispensed, the pharmacist must record the exact batch number. Not just the drug name. The batch. Why? Because if something goes wrong-like an unexpected side effect-the system needs to trace it back. Was it this batch? Or that one? This isn’t bureaucracy. It’s safety.
That’s why the IFPMA says traceability is non-negotiable. And pharmacists are on the front lines. They’re the ones handing the patient the vial with the batch code printed on it. They’re the ones logging it into the electronic record. They’re the ones who alert the doctor if a patient has a reaction and the source needs to be tracked.
This level of detail isn’t needed for generics. But for biosimilars? It’s critical. And it’s one more reason why pharmacists can’t just treat them like any other drug.
Why Adoption Is Still Slow-And How to Fix It
Biologics make up just 2% of all prescriptions in the U.S. But they account for nearly half of all drug spending. That’s a massive opportunity. A single biosimilar can cut costs by 15% to 35%. Multiply that across thousands of patients, and you’re talking about billions saved.
So why isn’t everyone switching? Three big reasons:
- State laws vary. Some states allow automatic substitution. Others require prescriber approval every time. That creates confusion. A pharmacist in New York can swap a biosimilar. One in Texas might not be able to.
- Payers and PBMs block it. Some insurance companies still pay more for the brand-name drug because of rebate deals. That means the patient pays more out-of-pocket-even if the biosimilar is cheaper for the system.
- Doctors are hesitant. Many haven’t been trained. They worry about liability. They don’t know the data. And they’re not used to pharmacists making these decisions.
The fix? Three things: First, update state laws to allow pharmacist substitution where safe. Second, eliminate rebate structures that discourage biosimilar use. Third, educate. Not just doctors. Patients too. And pharmacists? They need to be the ones doing the educating.
The Future: Pharmacists as Biotherapeutics Specialists
Biosimilars aren’t going away. More are coming every year. By 2030, over 50 new biosimilars could hit the market. And with them, a growing need for experts who understand how they work, how they’re made, and how to use them safely.
That’s why experts are calling for a new pharmacy specialty: biotherapeutics. Imagine pharmacists who specialize in biologics, not just pills. Who know the manufacturing nuances. Who track batch data like detectives. Who train doctors, counsel patients, and advocate for policy changes. That’s not science fiction. It’s already happening in clinics that got ahead of the curve.
For the pharmacist, this isn’t just another task. It’s a chance to lead. To take control of a process that’s too complex for anyone else to manage. To turn confusion into confidence. And to help patients get the care they need-without paying more than they have to.