As biosimilars continue to redefine the specialty drug landscape, payers and their associated pharmacy benefit managers (PBMs) are executing new strategies to capture a larger share of revenue. PBMs are partnering with manufacturers to co-develop and commercialize their own private-labeled biosimilar products. This coordinated approach provides value to both parties, as it enables them to siphon off market share from originator therapies and their competitors.
In this article, we explore how the fragmented rollout of Humira biosimilars exposed the drawbacks of a landscape in which each biosimilar manufacturer fought for market share on its own. Now that the three largest payer/PBMs have expanded their private-label subsidiaries to produce and co-commercialize Stelara biosimilars as well, how will the market respond? How payers react to this evolving landscape will have an impact on the ultimate viability of PBM white labeling.
Fragmented Humira Biosimilars Launch Results in Market Uptake Challenges
Despite enthusiasm over the cost-saving potential of the first large-scale rollout of biosimilars for a blockbuster drug, the 2023 launch of Humira (adalimumab) biosimilars was less momentous than expected. Several manufacturers offered adalimumab products with list prices similar to Humira’s, hoping that the promise of high rebates would entice PBMs to add them to formularies.
Another subset of manufacturers offered significantly discounted list prices during this time, with biosimilars priced at 55-86% less than Humira’s WAC. The remaining manufacturers offered both high-WAC and low-WAC options. Regardless of the pricing/rebating incentives offered, however, few payers opted to add biosimilars to their formularies. By the end of 2023, Humira still retained more than 80% of its patient base.
Manufacturers soon recognized that biosimilar adoption requires much more than just cost differentiation. Neither low prices nor high rebates were enough to drive uptake. In response, manufacturers began working with PBMs rather than against them, teaming up to commercialize and/or co-produce selected biosimilars. The first partnership of this kind debuted with the launch of CVS Health’s subsidiary Cordavis in the fall of 2023.
In April 2024, Cordavis removed Humira from many commercial formularies in favor of its partner Sandoz’s biosimilar, Hyrimoz, along with its own private-label Hyrimoz product, which quickly captured the majority of new prescriptions.
Vertical Integration Accelerates: The Rise of PBM-Owned Private-Label Biosimilars
By the end of 2024, the Cordavis success had spurred the other two major PBMs to leverage their subsidiary organizations to white-label biosimilars, a move which allowed them to also consolidate services and increase control throughout the supply chain.
First, Boehringer Ingelheim and Teva partnered with Quallent Pharmaceuticals, a subsidiary of the Cigna Group’s Evernorth Health Services, to expand access to citrate-free adalimumab-adbm. (Evernorth also owns Express Scripts, Cigna’s PBM.) Through Evernorth’s Accredo pharmacy, Quallent offered its biosimilar with $0 out-of-pocket costs for patients, a move that increased PBM/manufacturer alignment.
Most recently, in 2025, Nuvaila, a subsidiary of UnitedHealth Group’s OptumRx, partnered with Amgen to distribute both Amjevita, a Humira biosimilar, and Wezlana, a Stelara biosimilar, further representing growing PBM control over product selection.
These three PBM-affiliated entities represent the shift toward vertical integration in the biosimilar market. PBMs’ ability to gain greater formulary control through direct partnerships with manufacturers shapes how biosimilars are covered and accessed.
Unsurprisingly, payer perspectives on the growing power of payer/PBM entities have been divided since the beginning of this trend. In a mid-2024 MMIT Index survey, more than half of payers said they expected these new entities to have a positive impact on biosimilar competition.
On the other hand, several payers also noted that these entities would likely add undue complexity to an otherwise straightforward biosimilar market—an observation that has proven to be true.
Stelara Biosimilar Launch: A Case Study in PBM-Led Commercial Strategy
The 2025 launch of Stelara (ustekinumab) biosimilars began a coordinated, PBM-driven market strategy. In contrast to the Humira biosimilar rollout, PBMs had already increased their control over biosimilar access and pricing by the time the Stelara biosimilars were cleared for launch.
All but one Stelara biosimilar was given interchangeability status, streamlining substitution at the pharmacy level. On January 1, 2025, Amgen’s Wezlana became the first Stelara biosimilar to launch through an exclusive distribution model with Nuvaila. Three more ustekinumab biosimilars—Selarsdi, Pyzchiva, and Yesintek—launched soon after, all separately, with various PBMs. The staggered launch approach helped PBMs manage contracting dynamics and market disruption.
At the same time, the Stelara originator drug was excluded from many formularies in favor of PBM-preferred alternatives. Pricing discounts were also implemented, with Yesintek launching at approximately 90% below Stelara’s list price and Selarsdi entering the market at around an 85% discount. Collectively, exclusive distribution, formulary exclusions, and pricing decisions from this rollout allowed PBMs to shift from traditional rebate models toward direct PBM ownership and control of biosimilar distribution.
Despite the coordinated strategy, payers’ feelings remain mixed. Data from the Q1 2025 MMIT Index shows that payers representing 43% of commercial lives said they were “not at all likely” to place a biosimilar like Wezlana on formulary if their organization had no affiliation with the private-label distributor. This hesitancy highlights ongoing concerns within the evolving PBM biosimilar landscape.
Market Impact: Opportunities and Tensions in a Consolidating Landscape
PBM-owned private-label biosimilars continue to expand their presence. According to the Q1 2025 MMIT Index research, most payers plan to remove Stelara from their formularies by Q2 2026, citing improved patient affordability and better pricing for their organization as key drivers. While some payers remain cautious about the uncertainty surrounding the future of private-label entities—and some payers still prefer direct rebates from reference product manufacturers—the overall shift toward private-label biosimilars is evident.
PBMs now hold more control than ever before in the biosimilar landscape. Across MMIT reports, payers recognize that manufacturers are increasingly partnering with PBM-owned subsidiaries for the exclusion of reference products such as Humira and Stelara. They expect that biosimilar manufacturers will continue to form partnerships with private entities to gain market access.
Most payers agree that these new vertically integrated organizations offer several benefits, including lower costs and streamlined operations. As one pharmacy director said, these new entities mean “Lower prices, flourishing biosimilar market, more aggressive rebates from the origination, more aggressive portfolio contracts from the originator.”
On the other hand, many payers are also concerned over a lack of pricing transparency, conflicts of interest, and anticompetitive behavior. As one pharmacy director noted, “This might limit the number of players in the biosimilar market because they won’t get traction without white labeling, and that’s not good for competition.”
Payers will continue to make decisions based primarily on cost, but according to one CMO at a Blues affiliate, “The main challenge is to know which partnership with which entity is the best partnership to have.”
As the Stelara biosimilar rollout continues, market observers will be interested to see which biosimilars pick up the most market share in this new era. While it seems clear that vertical integration is now the standard strategy in the biosimilar market, it remains to be seen how the PBM co-commercialized biosimilars will fare as compared to their peers.
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