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How Will the Launch of Humira Biosimilars Impact Patients, Payers and IDNs?

By Jill Linder and Samantha Ngan

Across indications, biosimilar uptake is rapidly accelerating, with the number of biologics facing biosimilar competition more than doubling by 2026. This year’s impending launch of adalimumab biosimilars will serve as a case study for manufacturers, who will be studying the market’s response. Humira biosimilars have great potential to disrupt immunology market baskets, especially if multiple competitors employ aggressive discounting strategies.

To prepare for the impact of increased biosimilar competition in immunology indications in 2023, it is important to understand not only how payers and IDNs will respond, but how current patients are likely to navigate the transition. To learn more, MMIT conducted a large, syndicated study of payers and IDNs in November 2022, followed by a panel of 189 immunology patients. Our research reveals the following:

  1. The timing of formulary changes will differ for payers and IDNs.
    During previous biosimilar launches, payers typically made formulary changes after multiple options were available, while IDNs were more likely to make changes after the first launch. Based on our recent survey, these organizations plan to follow the same strategy for Humira biosimilars. IDNs are more likely than payers to make formulary changes once the first biosimilar becomes available for both their commercial and Medicare lines of business. While most payers plan to review the first biosimilar when it becomes available, they plan to wait until January 2024 to make changes to their formularies, when all biosimilars are available and have been on the market for at least six months.
  2. Payers and IDNs will only cover a few of the Humira biosimilars.
    Although 10 biosimilars are expected to launch in 2023, patients will likely be limited in their options. A majority of IDNs will only cover one to two adalimumab biosimilars in 2023 and 2024. About a third of IDNs expect to have Humira on formulary in 2023, with coverage continuing to decline in 2024. Similarly, in 2023 and 2024, payers expect to have an average of two biosimilars covered as a “preferred brand”; a majority of payers don’t expect to cover Humira by 2024.
  3. Marketing, cost, and first-to-market status are key factors to biosimilar success.
    According to IDNs and payers, Amjevita is perceived as having the highest likelihood of success among the 10 adalimumab biosimilars. The drug’s anticipated success is attributed primarily to positive awareness from its first-to-market status and Amgen’s marketing efforts. Our survey participants also name cost as a key factor that will have a large impact on the success of a particular biosimilar.
  4. Educating patients on biosimilars is both a need and opportunity.
    It is also important to understand how patients will be impacted by the new biosimilars. With the first biosimilar launch just a few weeks away, most surveyed immunology patients indicated they did not know what a biosimilar was. Only a few patients reported receiving information regarding Humira biosimilars in the past six months. Most patients also indicated that they either did not want to or were unsure about taking a Humira biosimilar.

    While patients may not currently be aware of the new market options, they will certainly be impacted. Most payers and IDNs plan to set a cutoff date where all new prescriptions for adalimumab must be for biosimilars. Approximately half of payers and IDNs will mandate that existing patients switch from the branded drug to a biosimilar replacement.

    Given this data, smart biosimilar manufacturers will take a patient-centric approach to securing market access for their drug. As payers and IDNS are eager to capitalize on cost-saving opportunities, most are planning to prefer a biosimilar over Humira—yet many patients are not aware of the potential for changes in their coverage. Manufacturers of biosimilars should invest in building brand awareness and strengthening relationships with patients, who may be surprised to find out that their Humira prescription has been switched to a biosimilar.

Pharma companies planning to launch a biosimilar in the near future need to be aware of the many dynamics at play in securing market access. Given historical data, IDNs and payers are likely to review biosimilars and make formulary changes on different timelines, which can impact manufacturers’ contracting strategies. To maximize market share, manufacturers should aim to launch their product as soon as possible and drive brand awareness with patients and prescribers. They should also be willing to offer a lucrative price to drive product uptake.

For more information on MMIT’s special biosimilars report and a free infographic, visit our Payer, IDN, and Patient Perspectives on Humira Biosimilars site.

© 2024 MMIT
Jill Linder

Jill Linder

Jill Linder is a Market Research Manager at MMIT.

Samantha Ngan

Samantha Ngan is a Senior Analyst, Episodic Content at MMIT.

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