Innovation is often measured and marked by disruption – particularly in health care. The health care system is constantly in pursuit of breakthrough treatments, many of which have the potential to change the landscape as we know it.
One example is biologic medications, which are complex medications made from natural and living sources. For many patients living with inflammatory conditions such as rheumatoid arthritis, Crohn’s disease, or plaque psoriasis, the availability of biologic treatments that help manage their symptoms has been life changing. In the two decades since the FDA approved the biologic drug Humira, it has become the world’s most prescribed medication while simultaneously getting more and more expensive, with price hikes totaling nearly 500% in the years following its approval.
Today, however, new interchangeable biosimilar treatments are readily available. After years of delays caused by patent thickets, biosimilars are at last disrupting a class of medications that for too long has been controlled by several brand-name biologics like Humira. With the availability of a range of biosimilars, we can further drive meaningful competition that will lead to lower costs for patients and plan sponsors, enabling them to afford new innovations in the pipeline.
Beginning next year, Express Scripts, the pharmacy services business of Evernorth, will take additional steps to support patient access to low-cost biosimilars while excluding Humira on its largest commercial formularies.
This step builds on Evernorth’s long-standing advocacy for greater biosimilar adoption and access to lower-cost alternatives. A new Humira biosimilar is currently available at $0 out of pocket for eligible patients of Accredo Specialty Pharmacy, which has the potential to help patients save about $3,500 per year. Express Scripts has included preferred biosimilars on its largest commercial formularies alongside Humira since February 2023, and it continues to evaluate the biosimilar market and ensure clients and patients can get the best outcomes at the best value.
“We’ve been thoughtful in developing a comprehensive approach that considers not just the formulary placement of biosimilars, but also each product’s clinical efficacy, interchangeability, available supply, dose, and concentration that will provide a seamless patient experience with these more affordable products,” said Adam Kautzner, president of Evernorth Care Management and Express Scripts.
When Humira is removed from commercial formularies in 2025, the following biosimilar products will continue to be available to Express Scripts commercial members:
- Cyltezo (adalimumab-adbm) and its unbranded version (Boehringer Ingelheim), the first low-concentration interchangeable biosimilar with Humira, now also available in high-concentration formulations
- Simlandi (adalimumab-ryvk) (Teva), the first interchangeable biosimilar with Humira, high concentration, 40mg strength
- Adalimumab-adaz (Sandoz), unbranded high-concentration formulation, with interchangeable 10mg, 20mg, and 80mg strengths and noninterchangeable 40mg strength
- High- and low-concentration interchangeable biosimilar products produced for Quallent Pharmaceuticals through agreements with multiple manufacturers
“As a pharmacy benefit manager, we lead the way in ensuring patients get the highest quality drugs at the lowest possible cost in the most patient-friendly way possible,” Kautzner said. “With this latest update, we’re prepared to embrace the savings biosimilars offer and pave the way for access to the next wave of prescription drug blockbusters coming down the pike.”
