Optum Rx’s Choice: Hyrimoz, Cyltezo and Amjevita


Optum Rx will include the three biosimilars on its standard formulary at parity with Humira.

Starting July 1, Optum Rx, UnitedHealth Group’s PBM, will offer access to three biosimilars of the blockbuster autoimmune therapy Humira (adalimumab). It treats patients with rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis and plaque psoriasis. The three that will be offered include:

  • Sandoz’s Hyrimoz and adalimumab-adaz, both high concentration treatments, their high-list and low-list products, respectively.
  • Boehringer Ingelheim’s Cyltezo, the first interchangeable biosimilar, and, when available in 2024, access to its low-list version.
  • Amgen’s Amjevita, both high-list and low-list versions, which were added earlier this year.

Optum Rx will include the biosimilars on the standard formulary on parity with Humira. All four products will be on Tier 2 of standard formularies with prior authorization required and quantity limits upon launch, an Optum Rx spokesperson said.

In addition, the company said it will continue evaluating the addition of new entrants to the adalimumab category this year.

Related: OptumRx to Cover Amgen’s Biosimilar of Humira

OptumRx was the first PBM to make public its plans for the Humira biosimilars when it announced in November 2022 that it would include three of the biosimilars. At the time, OptumRx leaders said they estimate double-digit client net cost improvement in 2023 compared with 2022 as a result of the Humira biosimilars. “Our independent pharmacy & therapeutics committee has reviewed all the FDA-approved biosimilars to maintain clinical quality of care,” the company said in a statement. “Biosimilars added at parity will optimize patient, provider, and client choice and flexibility.”

Amjevita was the first of the Humira biosimilars to launch in January. It was introduced with two-tiered pricing: The first is a 5% below the current Humira price of $6,922 for a four-week supply. The second would be 55% below the current Humira list price. U.S. sales of Humira were up 9.9% to more than $5 billion in 2022, the company is expected to lose significant revenue as a number of Humira biosimilars come to market this year.

A high concentration, citrate-free version of Hyrimoz was approved in March. FDA had already approved a low-concentration formulation of Hyrimoz back in 2018. Sandoz will launch both versions on July 1, 2021.

Boehringer Ingelheim’s Cyltezo, the first interchangeable Humira Biosimilar, Cyltezo was approved as a biosimilar in 2017 and received Interchangeable designation approval in 2021. Additionally, a pen formulation was approved last month. A company spokesperson said pricing information will be available when Cyltezo launches in July.

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