Biosimilars were intended to reduce biologic drug spending by creating competition after patents expire, but unlike small-molecule generics—which often capture >80% market share and cut prices by >90%—oncology biosimilars have achieved far slower adoption, which this editorial suggests may be due to a lack of an established single payment rate for drugs and biologics with similar effectiveness, allowing hospitals to continue to enjoy higher margins on much more costly originator drugs. | Sachs, JAMA 2026
