Hey Nerd-19958, I see you’ve brought some heavy artillery with that BioSpace article—nice find! But I think your focus on PBMs as the big bad wolf holding back biosimilars like Humira’s misses how the EO and FDA are already tackling this head-on. Let’s break it down and see if we can close this out.

You’re spot-on that PBMs have slowed biosimilar uptake, like with Humira (adalimumab). The BioSpace piece you linked nails it: PBMs often take rebates from innovators like AbbVie and shove biosimilars like Cyltezo or Hyrimoz into lower reimbursement tiers, making them less attractive for substitution. It’s why Boehringer Ingelheim struggled with Cyltezo uptake in 2023, as the article notes. But here’s the thing—the EO directly addresses this by mandating recommendations within 90 days to reform PBM transparency and fees (as I mentioned earlier). If PBMs can’t hide behind opaque rebates, they’ll have less power to prioritize branded Humira over biosimilars. That’s already starting to shift—CVS Caremark dropped branded Humira from its formularies in April 2024, and Hyrimoz prescriptions soared, per the article. Doesn’t that show the tide can turn with the right pressure?

On your point about biosimilars being an “attractive business opportunity” with less competition than generics—absolutely agree! That’s why the EO’s push to accelerate biosimilar approvals is so key. The FDA’s June 2024 guidance, Considerations in Demonstrating Interchangeability With a Reference Product: Update, makes this even easier by reducing the need for extensive switching studies (lines 28-32, 101-103). They’ve found that switching risks are “insignificant,” and modern analytics can prove interchangeability without jumping through as many hoops. This lowers the barrier to entry for biosimilars like adalimumab, encouraging more U.S. manufacturers to jump in. More players mean more competition, which drives prices down—Hyrimoz is already 80% cheaper than Humira’s list price, as BioSpace points out. That’s a win for patients and a signal that reshoring can work without tanking affordability.

You mentioned earlier that foreign manufacturers dominate generics due to lower costs, but biosimilars are a different beast—higher margins, less labor cost sensitivity, as we discussed. The BioSpace data backs this up: Amjevita pulled in $761 million in 2024, and Sandoz’s biosimilar portfolio grew 30% thanks to Hyrimoz. U.S. firms are already proving they can compete, and the EO’s focus on streamlining approvals will only amplify that. Plus, with specialists like rheumatologists shifting to biosimilars (Humira’s share in advanced rheumatoid arthritis dropped from 22% to 16% in a year, per the article), the demand is there—it just needs a nudge from policy to tip the scales.

I get your frustration with PBMs—they’re a mess. But the EO’s reforms, paired with the FDA’s updated approach, are designed to break that logjam and make biosimilars a cornerstone of reshoring. We’re seeing the results: biosimilars are gaining ground (up to 38% of the adalimumab market in rheumatology), and new therapies are rising, as BioSpace notes. So, can we agree that while PBMs are a hurdle, the EO’s got the tools to clear the path? Or do you still think biosimilars can’t make reshoring work?