‘New Starts’ on Brand-Name Products? Pull Levers to Maximize Biosimilars, Says Scripius Formulary Manager

Health plans and pharmacy benefit managers (PBMs) are increasingly using formulary placement and a variety of other strategies and tactics to encourage patients to switch from brand-name reference biologics to biosimilars. Biosimilars, which are supposed to yield cost savings, often do.

But perhaps because of direct-to-consumer advertising and other marketing efforts, a large percentage of patients who are starting a biologic for the first time take a brand-name drug.

For the proponents of biosimilars — the companies that make them, payers who hope to realize the savings, healthcare-cost hawks seeking ways to cut U.S. spending — these "new starts" on the brand-name products look like setbacks next to all the efforts to convert existing prescriptions from the brand-name products to the biosimilars.

“It’s not a ‘leaky bucket,’ per se, but it is something that you're definitely needing to watch, see where your trends are going, and pull whatever levers you can along the way to maximize the biosimilars,” said Cody Olsen, Pharm.D., director of pharmacy, PBM formularies at Scripius during an interview at the 2025 Annual National Conference of the Pharmacy Benefit Management Institute held earlier this month in Orlando, Florida. Scripius is a PBM owned and operated by the Intermountain Health health system headquartered in Salt Lake City, Utah. Olsen was on a panel on managing autoimmune diseases that focused on biosimilars.

Humira (adalimumab) and Stelara (ustekinumab) are biologics frequently prescribed as treatments for a wide of variety of autoimmune diseases. Biosimilars to Humira came on the market in 2023 and to Stelara this year. Humira and Stelara have been big-budget drugs for years, so the arrival of their biosimilars looms large as an opportunity for cost savings.

Olsen said it is important to develop utilization management criteria for brand-name biologics such as Skyrizi (risankizumab), Rinvoq (upadacitinib), and Dupixent (dupilumab) “so that patients that do need those drugs are meeting specific criteria…they’re getting the right drug at the right time for the right price.”

Scripius does a “thorough clinical evaluation” of drugs, he said, and both brand-name products and biosimilars are among its first-line drugs.