PBMs Start to Embrace Biosimilars

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Pharmacy benefit managers (PBMs) are slowly coming around and putting biosimilars on their formularies. IQVIA estimates that the dearth of a Humira (adalimumab) biosimilars last year cost patients and employers cumulatively $6 billion.

After standing in the way of patients and their access to Humira biosimilars (adalumumab), CVS is now going all in by pushing a biosimilar competitor, Hyrimoz, high up on its formulary and taking Humira down.

Meanwhile, a huge specialty pharmacy, Accredo (Evernorth) is offering Humira biosimilars for the first time starting in June this year.

Throughout 2023, the first year of Humira biosimilar competition, CVS clung to Humira as its preferred drug, which helped to almost stifle sales of the nie competitor biosimilars that entered the market that year. By the end of 2023, biosimilars had just 2% of the Humira market.

PBMs and their specialty drug pharmacies control at least 80% of the pharmaceutical market in the United States, and last year their lucrative deals with Humira’s maker, AbbVie, made it undesirable for them to switch to biosimilars, even though these competitor biologics were selling at wholesale acquisition cost (WAC) discounts of 55% to 86% less than Humira.

For example, the biosimilar Hulio was offered last year at a WAC of $498 for a month's supply, versus $3,461 for Humira, according to a Samsung Bioepis biosimilar report.

Still, the vast majority of prescriptions filled in 2023 were for the Humira originator product, prompting market research group IQVIA to conclude that “maintaining patients on Humira comes at a cost of up to about $6 billion per year for patients and employers, compared to a full transition to adalimumab biosimilars.”

IQVIA is doing a tracking study in conjunction with the Biosimilars Council to understand Humira biosimilar progress and the reasons for its success or failure.

IQVIA concluded that even at the net WAC price of $2,129 that health plans were paying for Humira, they still could have saved money by transitioning to biosimilar versions, which IQVIA said in general were available for a net monthly price of less than $1,000.

CVS has now asserted that it aims to go into the biosimilar business wholesale by contracting with biosimilar manufacturers and developing its own low-cost versions.

The initial contract to supply Hyrimoz, a Sandoz biosimilar, will represent an 80% list price savings off the original cost of Humira, according to CVS. This sales program has already launched, causing Hyrimoz’s share of new Humira prescriptions to soar “from about 5% at the end of March to about 35% to 45% at mid-April, the Wall Street Journal reported, quoting Evercore analyst Elizabeth Anderson.

She reportedly said the deal is worth from $50 million to $100 million in additional yearly income for CVS.

IQVIA takes the opposite view of PBM's potential profits from biosimilars, saying that its research suggests they will suffer an 87% profit loss from the transition away from Humira, owing to lack of rebates and lower revenue from WAC fees.

It is unclear what this sea change in PBM's support for biosimilars means for biosimilar manufacturers. The Biosimilars Forum has in the recent past castigated PBMs as being a sepsis to free market dynamics, although one of their members is Sandoz, which has much to gain from its new partnership with CVS over Hyrimoz. CVS controls 25.7% of the retail pharmacy market in the U.S.

Evernorth’s Accredo is expected to negotiate with multiple biosimilars makers to supply the post Humira market.

These changing conditions may cause the Biosimilars Forum to change its tune about PBMs, though biosimilars makers were severely wounded by lackluster Humira biosimilars last year.

Patients appear to have been among the biggest losers so far, as in 2023 just 33% of patients who received a script for a Humira biosimilar were able to get it filled in the first month, owing to gateway barriers set up by the largest payers, IQVIA stated.

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