Biosimilar Adoption in Personal Injury: What Attorneys Need to Know

James Wong — Founder & CEO, LienScripts | March 4, 2026 | 7 min read

Biosimilar medications are expanding treatment options for PI patients with severe injuries requiring biologic therapy. LienScripts pharmacy lien services ensure access to both biosimilar and reference biologic medications without insurance barriers or formulary restrictions.

A biosimilar is a biologic medication that is highly similar to an already-approved reference biologic product, with no clinically meaningful differences in safety, purity, or potency. Biosimilar adoption is accelerating in 2026 as new products enter the market for pain management, inflammatory conditions, and autoimmune disorders that frequently arise or worsen after personal injury. For PI attorneys, biosimilar availability creates both opportunities and challenges: more treatment options for clients, but also potential disputes about medication selection in demand packages. Pharmacy lien services through LienScripts ensure patients access the appropriate biologic or biosimilar based on clinical need rather than insurance formulary economics.

• Biosimilars are biologic medications highly similar to approved reference products with no clinically meaningful differences
• New biosimilar approvals in 2026 expand options for injury-related inflammatory and pain conditions
• Insurance formulary placement of biosimilars versus reference biologics creates patient access disputes
• LienScripts pharmacy liens provide access to the prescriber's chosen biologic without formulary interference
• LienScripts generates a MERIT (Medication Evaluation & Rationale for Injury Treatment) report for every case, providing pharmacist-signed documentation for demand packages

Biosimilars Relevant to Personal Injury

Not all biosimilars are relevant to PI cases. The biosimilars that matter for personal injury practice involve medications used for conditions that arise from or are exacerbated by traumatic injury:

Adalimumab biosimilars. Multiple adalimumab (Humira) biosimilars are now available for inflammatory conditions. When a car accident exacerbates a pre-existing autoimmune condition or triggers inflammatory arthritis, adalimumab or its biosimilars may be prescribed.

Etanercept biosimilars. Biosimilar etanercept products are used for inflammatory conditions that may be worsened by traumatic injury, including ankylosing spondylitis and psoriatic arthritis.

Infliximab biosimilars. Used for severe inflammatory conditions, infliximab biosimilars may be prescribed when injury exacerbates conditions like rheumatoid arthritis or inflammatory bowel disease.

According to James Wong, PharmD, founder of LienScripts, "Biosimilars give prescribers more options for complex injury cases. The clinical decision about which biologic to use belongs to the prescriber, not the insurance formulary. The pharmacy lien ensures that decision is respected."

The Insurance Formulary Problem

Health insurers and PBMs have been aggressively placing biosimilars on preferred formulary tiers while moving reference biologics to non-preferred tiers or requiring prior authorization. This creates a specific problem for personal injury patients:

Non-medical switching. Patients stabilized on a reference biologic may be forced to switch to a biosimilar for insurance coverage reasons rather than clinical reasons. For PI patients, any medication change during an active case creates documentation complications and potential symptom changes that can be attributed to the switch rather than the injury.

Step therapy to biosimilars. Some insurers require patients to try a biosimilar before approving the reference biologic, even when the prescriber has clinical reasons for choosing the reference product.

Automatic substitution disputes. State laws vary on whether pharmacies can automatically substitute a biosimilar for a prescribed reference biologic. In some states, the prescriber must specifically authorize substitution.

How Pharmacy Liens Simplify Biologic Access

The LienScripts pharmacy lien dispenses the medication the prescriber orders, whether it is a reference biologic or a biosimilar. Because the lien operates without insurance adjudication:

• No formulary preference applies
• No step therapy from biosimilar to reference product is required
• No non-medical switching occurs
• The prescriber's clinical judgment determines the medication

This is particularly important for complex injury cases where a patient needs biologic therapy. The prescriber can choose the medication based on the patient's clinical profile, the specific injury, prior medication history, and therapeutic response rather than insurance economics.

For attorneys managing complex medication regimens for PI clients, the pharmacy lien ensures that biologic therapy decisions are clinically driven.

Documenting Biologic Therapy in Demand Packages

Biologic medications are high-value prescriptions that require careful documentation in demand packages. The MERIT report from LienScripts documents every dispensing, including the specific product (reference biologic or biosimilar), dosing schedule, and administration timeline.

Attorneys should be prepared for defense challenges to biologic therapy in PI cases:

Medical necessity. Defense may argue that the biologic was not necessary for the injury. Clinical documentation from the prescriber explaining the connection between the injury and the need for biologic therapy is essential.

Biosimilar availability. Defense may argue that a cheaper biosimilar was available and should have been used. The prescriber's clinical rationale for the specific product choice should be documented.

Pre-existing condition involvement. If the biologic treats a condition that existed before the injury, the eggshell plaintiff doctrine applies: the defendant takes the plaintiff as they find them, including pre-existing conditions worsened by the injury.

For guidance on documenting medication costs in settlement contexts, the biologic therapy documentation principles align with standard demand package practices.

Biosimilar Trends Attorneys Should Monitor

Expanding Indications

New biosimilar approvals continue to expand the range of conditions treatable with more affordable biologic options. Attorneys handling cases involving severe inflammatory conditions should be aware of newly available biosimilars that may offer their clients additional treatment pathways.

Interchangeability Designations

The FDA is granting interchangeability designations to certain biosimilars, which allows pharmacy-level substitution without prescriber intervention in some states. Attorneys should understand whether their client's medication was subject to automatic substitution and whether that substitution was clinically appropriate.

State Substitution Laws

State laws governing biosimilar substitution vary significantly. Some states require pharmacist notification to the prescriber, some require patient consent, and some allow automatic substitution for interchangeable biosimilars. Attorneys practicing in states with active biosimilar substitution laws should understand how those laws interact with pharmacy lien dispensing.

Practical Guidance for Attorneys

Establish a pharmacy lien through LienScripts when a client requires biologic therapy for an injury-related condition. The lien ensures that the prescriber's biologic selection is filled without insurance interference, the dispensing is documented in the MERIT report, and the medication timeline supports the demand package narrative. As biosimilar adoption continues expanding, this direct-access model protects both the patient's clinical care and the attorney's case documentation.