Requiring Humira Biosimilars Results in Huge Savings for Navitus Clients

Commercial clients of Navitus Health Solutions saw a 60% reduction in net cost per claim after the PBM removed the arthritis drug Humira (adalimumab) from its formularies in favor of three biosimilar options. Navitus is forecasting annualized net savings of more than $100 million with the transition to adalimumab biosimilars that have a low wholesale acquisition cost and low rebates, according to the company’s most recent Drug Trend Report.

Navitus removed Humira from its formularies in June 2024, preferring instead adalimumab-adaz (an equivalent of the biosimilar Hyrimoz), adalimumab-fkjp (an equivalent of the biosimilar Hulio), and Hadlima. Within three months of the formulary change, 94% of members successfully switched to a biosimilar, according to an analysis done by Navitus researchers.

Clients experienced more than $315 million in upfront cost savings and a 60% reduction in net costs per claim. Participating plans saved $20.79 in per member per month (PMPM) cost before rebate as a result of the change to the Humira biosimilars. Patients also saw a benefit. The average patient copay decreased nearly 97%, from $4.53 per month with Humira to $0.15 per month with biosimilars. Patients in a coinsurance structure that remained on adalimumab therapy saved an estimated $1,180 per month in out-of-pocket costs.

This year, Navitus plans to remove Stelara (ustekinumab), another high-cost drug used to treat psoriasis, psoriatic arthritis, and inflammatory bowel diseases, from its formularies on July 1, 2025. Stelara, developed by Johnson & Johnson, has a list price of $25,497.12 every 8 weeks for the 90 mg dose.

Navitus’ specialty pharmacy will offer an unbranded biosimilar that the PBM estimates will save between $112,000 and $336,000 per patient per year compared with the annual per-patient cost of the reference product. Lumicera Health Services has made a purchase agreement with Anda, a subsidiary of Teva Pharmaceutical, for a lower-priced biosimilar version of Stelara.

The Stelara biosimilars are expected to deliver net savings of 85% per claim and significantly drop prices for ustekinumab in 2025 and 2026, the Navitus report predicts.

Ryan Schmidt

Ryan Schmidt, associate director of client financial support at Navitus, said the switch to the Stelara biosimilars will keep spending down this year. “Utilization is going up quite a bit,” he said in an interview. “We saw utilization across the board come up, and that includes the really heavily used categories like antidepressants or blood pressure or cholesterol, which is not a big cost driver because this is a generic category.”

Specialty Trends

The Navitus drug trend is calculated by comparing the net total cost per-member per-month (PMPM) for 2024 to that for 2023. Net cost PMPM represents full-year data for total member copays and plan-paid amounts minus manufacturer rebates and fees. This value is divided by the total number of members and by 12 months of the year. The data represents employer plan sponsors and health plans.

About 30% of Navitus clients spent less in 2024 than in the previous year, while the overall drug cost trend was 7%. The growth was driven by increased utilization of newer, more costly brand drugs, despite high use of the generic drugs. Both specialty and non-specialty categories contributed to increased trend.

The specialty area is expected to continue to grow, Navitus indicated in its report. About 75% of medications anticipated to be approved in the next few years are specialty drugs.

Less than 2% of Navitus’ commercial population used a specialty medication, but these drugs represented 52% of the net spend because of their high costs, the trend report found. The targeted immunomodulators, including Humira and Stelara, represented nearly 40% of all specialty spending in 2024.

Oncology spending also continues to grow as well. Oncology net trend increased more than 13%, driven by both higher utilization and unit cost: utilization of newer breast cancer treatments (Kisqali, Verzenio) increased 20%, driving overall cost.

“Three of the top five drugs used to treat cancer are generic products,” Schmidt said.

But he said in breast cancer, for example, products such as Verzenio (abemaciclib) and Kisqali (ribociclib) continue to be approved for expanded indications. Both are approved to treat patients with HR+/HER2 early and metastatic breast cancer.

“These have great survival rates in breast cancer, and they’re wonderful products, but they are $10,000 to $15,000 per month. So those are the costs that employers are paying,” Schmidt said. “We would not prevent their use in these cancers, but we want to make our clients aware that utilization is likely to increase if it’s the right product for the right patient.”

Lilly’s Verzenio was approved to treat early breast cancer in March 2023 and metastatic breast cancer in September 2017. It has a wholesale acquisition cost of $4,082.52 for 14 tablets. Novartis’ Kisqali was approved to treat early breast cancer in September 2024 and metastatic breast cancer in July 2028. It was a wholesale acquisition cost of $14,148 per 28-day cycle for the 400-mg dose and $17,685 per 28-day cycle for the 600-mg dose.

Medications such as glucagon-like peptide-1 receptor agonists continue to put financial pressure on plan sponsors as utilization for diabetes treatment increased 26% year-over-year, the Navitus report found.

Related: Increased Use of GLP-1 Drugs Adds to Navitus’ Drug Spend for 2023

The use of GLP-1 drugs continues to add to drug spending, although the impact is not as large as last year, Schmidt said. The Navitus spend report doesn’t look at the impact of GLP-1 therapies used for obesity. “Not a ton of our clients cover weight loss today, because it’s so expensive, and the cost is something that they’re concerned about maintaining long term,” he said.