Zitter Pulse Check: Rheumatoid Arthritis (August 2023)


Rheumatoid arthritis (RA) is a high-cost category with an increasing number of therapies that treat the condition. To help stakeholders absorb datapoints and perceptions from all directions and synthesize those insights into a tangible strategy for RA, Zitter Insights surveys a leading panel of pharmacy and therapeutics (P&T) decision makers at payers and integrated delivery networks. The Managed Care Biologics and Injectables Index combines deep payer insights with the industry standard in market access information to produce quarterly reports and insights summaries on leading specialty brands.

Payer Management

Payers with almost three-fourths of Medicare covered lives and more than four-fifths of commercial beneficiaries said that managing branded treatments for RA is a high or very high priority for them. The level of aggression in how payers manage the condition varies: Commercial payers with almost half of lives said they were somewhat aggressive, while Medicare payers with almost the same amount of beneficiaries said their approach is very aggressive.

Almost two-thirds of rheumatologists said they were highly satisfied with available treatments for RA, compared with payers covering more than one-third of commercial lives and approximately one-quarter of Medicare beneficiaries that said the same. Commercial payers with two-thirds of lives said that therapies to treat the condition have a high budget impact.

Key Findings

Manufacturer Ratings

Payers, rheumatologists and practice managers were asked to rate manufacturers of RA medications on six different metrics: overall commitment to the disease, account representative support, patient/family support resources, patient copay assistance, physician education/support and hub services. Payers stated that AbbVie Inc. was the top company in hub services while Pfizer Inc. was the best in the other five categories. Rheumatologists said Pfizer was No. 1 in physician education/support and Amgen was the top firm in patient copay assistance. In overall commitment to the disease, AbbVie and the Janssen Pharmaceutical Companies of Johnson & Johnson tied for the top slot, while AbbVie was named the best manufacturer for the last three metrics. Practice managers named Amgen Inc. the top firm in all six categories, tying Pfizer for best at account representative support and AbbVie for patient copay assistance.

Humira Biosimilars

As of late July 2023, eight biosimilars of AbbVie Inc.’s Humira (adalimumab) had launched onto the U.S. market. Payers covering more than two-thirds of commercial lives said they expected to mandate switching from the reference drug to biosimilars compared with those representing one-third of Medicare beneficiaries. Respondents with almost half of Medicare lives said they anticipated allowing providers to make the decision on whether they wanted to prescribe Humira or a biosimilar, a response given by commercial payers with about one-fifth of beneficiaries. Among factors that respondents said they expected will contribute to successful biosimilar launches, favorable rebates/discounts and the ability to contract were cited as important. The lack of portfolio opportunities from a manufacturer, absence of experience with payer contracting and lack of a salesforce were some of the top factors expected to lead to unsuccessful launches.

Social Determinants of Health

The top social determinants of health initiative that commercial and Medicare payers offer for their disadvantaged members with RA is greater access to telehealth, provided by respondents with approximately three-quarters of lives. Other common services for commercial payers were providing educational content about healthy living and offering resources to assist in health/medicine language barriers. Medicare payers also often provided educational content about healthy living, as well as transportation to and from medical appointments. Rheumatologists said that socioeconomic status is the top non-medical factor that impacts their RA patients’ access to health care services, followed closely by education and health literacy, and occupation and job security.



Message: “Account Manager discussed Humira biosimilar. Main discussion topic centered on cost of the product and if we would prefer a high WAC [wholesale acquisition cost], low WAC or both. AM discussed Coherus’ expected strategy around this topic.”

Payer Thoughts: “This was a good conversation. I believe the high WAC approach will not work for the biosimilar manufacturers. It will just be too difficult to challenge AbbVie on the rebate side. I agree that this is the approach that the big 3 [PBMs] would prefer, tying more dollars into rebates. However, I think low WAC may be the strategy to get more market share early (and later), regardless of line of business [LOB]. How do the biosimilars get market share is the question. Obviously cost is a big factor, but also a factor is getting providers/patients acclimated to your brand name, device, etc. The way to do this is to get on Medicaid formularies early, not try to compete with Humira in the other LOBs. Low WAC is the path to getting on Medicaid formularies, not high WAC. I think the low WAC versions will be better known in the industry when 2024 starts and payers start to think about blocking Humira in commercial/exchange/Medicare. I am suggesting low WAC-only versions to most manufacturers.”

Several Biosimilars of Humira Launched This Month With Varying WACs

As expected, early July saw the launch of multiple biosimilars of AbbVie Inc.’s Humira (adalimumab). Most of them launched with wholesale acquisition costs (WACs) just slightly less than that of the reference drug, but a few undercut that price fairly significantly. Of the seven agents — including branded and unbranded versions of Hyrimoz (adalimumab-adaz) from Sandoz, a division of Novartis Pharmaceuticals Corp. that will be spun off into a new publicly traded standalone company in the second half of this year, and Biocon Biologics Limited’s Hulio (adalimumab-fkjp) — five launched with a WAC 5% off Humira’s $6,922 price tag.

Subscribers to AIS Health’s RADAR on Specialty Pharmacy may read the article online

Coherus Reveals New Pricing Strategy for Its Humira Biosimilar

One manufacturer recently revealed that it would launch its biosimilar of AbbVie Inc.’s Humira (adalimumab) at a huge discount not seen before in the U.S. While it almost certainly will be able to get some uptake in a market that’s about to become highly competitive, commercial payers who favor high list price/high rebate therapies are likely to not cover the agent, say industry experts.

On June 1, Coherus BioSciences, Inc. revealed that it would launch Yusimry (adalimumab-aqvh) in July with a list price of $995 per carton — an 85% discount off reference drug Humira’s (adalimumab) $6,922 price tag. The tumor necrosis factor (TNF) inhibitor, first approved Dec. 17, 2021, is a low concentration, citrate-free version of Humira, and it has approval for most of the reference drug’s indications.

Subscribers to AIS Health’s RADAR on Specialty Pharmacy may read the article online

© 2024 MMIT
AIS Health Staff

AIS Health Staff

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