May 23, 2024

Will the CVS Humira Biosimilar Initiative Spur Similar Approaches?

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AbbVie’s Humira (adalimumab) has been one of the world’s highest grossing drugs in history 1 and biosimilar utilization was uncertain when Humira’s patent expired in 2023. Surprising even AbbVie, Humira retained stronger retention than 2023 forecasts 2.

However, that may change rapidly in 2024 as CVS introduced an initiative to remove Humira from its national commercial formularies and replace it with a co-branded product 3. If CVS is successful, it may spur a profound market shift in driving biosimilar adoption as competitors OptumRx 4 and Express Scripts 5 have expanded their biosimilar coverage but not indicated any phasing out of Humira.

CVS announced this change on January 3rd, 2024 with an implementation date of April 1st, 2024 with their subsidiary Cordavis. Cordavis is also acquiring two similar biosimilars, contracting with Sandoz for Hyrimoz and Organon/Samsung Bioepis for Hadlima 6. This shift is significant in that it counters the historical trend of increasing biosimilar exclusions in formularies 7, according to a white paper by Xcenda:

These exclusions were designed to encourage usage of lower net cost drugs, which can be the reference product when factoring in manufacturer rebates. This element and the cautious tendency of plans, providers, and patients in examining the efficacy and safety of switching medications 8 stymied biosimilar utilization but that may change soon.

However, there are some undetermined factors surrounding how middle-market PBMs and health plans will approach biosimilar adoption. These entities don’t command the bargaining power to win the same scale of favorable manufacturer or wholesaler contracts that their larger competitors can. Still, a recent study from IQVIA highlighted that retaining Humira utilization would cost health plans significantly 9 and could drive them to increase pressure on their PBMs for different solutions.

All these factors highlight how broader biosimilar adoption could have an immense impact on the pharmaceutical world. Shifts in formulary and rebate strategy will be common as benefit managers, health plans, and insurers seek savings while manufacturers pivot to evolving demand. While largest PBMs and health plans have the leverage to explore increased adoption, but the rest of the industry will face more complicated paths forward.

Sources:

1 Humira Exclusivity Expires in 2023: Will Biosimilar Boom Benefit Patients or Industry?

2 After a Year on the Market, Humira Biosimilars Aren’t Making Much of a Dent

3 CVS Caremark Accelerates Biosimilars Adoption Through Formulary Changes

4 Optum Rx Expands Choice Humira Biosimilars