Coverage of First Humira Biosimilar Varies on ‘Big Three’ PBMs’ Formularies

Following the launch of Amgen Inc.’s Amjevita (adalimumab-atto), a slew of other FDA-approved Humira (adalimumab) biosimilars entered the U.S. market in July under settlement agreements with Humira originator AbbVie Inc. Major PBMs quickly announced that they would add more biosimilars to their formularies to compete with Humira.

At the end of June, UnitedHealth Group’s Optum Rx said it will place Boehringer Ingelheim’s Cyltezo (adalimumab-adbm) and Sandoz’s Hyrimoz (adalimumab-adaz) on its formulary at parity with Humira starting July 1. The Cigna Group’s Express Scripts then said it would add three biosimilars — Cyltezo, Hyrimoz and adalimumab-adaz (the unbranded equivalent of Hyrimoz) — to its list of preferred drugs.

As the first Humira biosimilar entering the U.S. market in January, Amjevita was made available at a list price (or wholesale acquisition cost) that was 55% below Humira’s brand price, or at a list price 5% below that of Humira, and it was placed in all three major PBMs’ formularies. Currently, over 75% of commercial enrollees have plans that put Amjevita on the preferred/preferred (prior authorization and/or step therapy) tier and covered/covered (PA/ST) tiers under the pharmacy benefit, while 73% of enrollees have plans that place Humira on those tiers, according to coverage policy analysis from MMIT Analytics (AIS Health is a division of MMIT). “Preferred” refers to product that is defined by the plan to be covered at the lowest level copay for brand products and most commonly includes preferred brands. “Covered” refers to product that is defined by the plan to be covered at a higher copay and most commonly includes non-preferred brand products.

CVS Health Corp.’s Caremark mainly placed Amjevita on its covered tier with utilization management restrictions, while Express Scripts generally put the biosimilar on the preferred tier with PA or ST for its commercial formularies. Meanwhile, most Optum Rx enrollees have plans that put the drug on either the preferred (PA/ST) or covered (PA/ST) tier — although tier placement varied considerably across different states.

On July 1, 2023, Organon and Korean partner Samsung Bioepis launched its biosimilar Hadlima (adalimumab-bwwd) with a list price of $1,038 for a carton containing two pre-filled pens or syringes. According to the companies, this is an 85% discount compared to Humira’s list price. Soon after, New Jersey-based Celltrion announced that its biosimilar Yuflyma (adalimumab-aaty) was available to patients for a monthly list price of $6,576.50, and Coherus Biosciences launched its biosimilar Yusimry (adalimumab-aqvh) at a list price of $995 per carton for two autoinjectors.

This infographic was reprinted from AIS Health’s biweekly publication RADAR on Drug Benefits.

© 2024 MMIT
Jinghong Chen

Jinghong Chen Reporter

Jinghong has been producing infographics and data stories on employer-sponsored insurance, public health insurance programs and prescription drug coverage for AIS Health’s Health Plan Weekly and Radar on Drug Benefits since 2018. She also manages AIS Health’s annual executive compensation database for top insurers and Blue Cross and Blue Shield affiliates. Before joining AIS Health, she interned at WBEZ, Al Jazeera English and The New York Times Chinese. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting.

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