Evernorth offering Humira biosimilar for $0 out-of-pocket

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Evernorth Health Services, a subsidiary of Cigna, will have a Humira biosimilar available for $0 out-of-pocket for eligible patients of its specialty pharmacy Accredo beginning this June.

The high- and low-concentration interchangeable biosimilar will be produced for Evernorth's affiliate private-label pharmaceutical distributor, Quallent Pharmaceuticals, through agreements with multiple manufacturers. It will be available at $0 out of pocket for most patients through Quallent's copay assistance program.

Evernorth estimated the program will save individual patients around $3,500 on average per year. Evernorth Health Services is also home to Express Scripts, telehealth outfit MDLIVE and data analytics company eviCore.

WHAT'S THE IMPACT?

The biosimilar price will be about 85% lower than the list price for Humira.

More than 100,000 Accredo patients currently use either Humira or one of its biosimilars, supported by specialty-trained pharmacists and nurses in Accredo's Therapeutic Resource Center for inflammatory conditions. Accredo's 15 condition-specific Therapeutic Resource Centers connect patients with pharmacists and nurses, helping to ensure patients receive care from clinicians who specialize in their condition.

Patients who stand to potentially benefit include those with inflammatory conditions, such as Crohn's disease and rheumatoid arthritis. Accredo helps them to work with their physicians, counsels them on therapy, administers medications and helps them in coordinating copay assistance and securing coverage through their health plans.

According to the company, it helped patients save roughly $2.8 billion in 2023 by connecting them with copay assistance programs.

THE LARGER TREND

Express Scripts, also a part of Cigna's Evernorth subsidiary, added three Humira biosimilars to its National Preferred Formulary in 2023.

According to Express Scripts trend data, inflammatory medications represented nearly 25% of total drug spend across its commercial book of business in 2022. Evernorth analysis further estimates that competition created with biosimilars can save the U.S. $225 billion to $375 billion in total pharmacy spend over the next decade.

Dr. Adam Kautzner, president of Express Scripts, said in a statement that Humira has had little competition to date, which is reflected in its list price, which is 470% higher than when it was first introduced. By adding clinically equivalent biosimilars to its formulary, Kautzner said Express Scripts can drive greater savings for its clients.

That move came shortly after Ohio Attorney General Dave Yost accused pharmacy benefit managers Express Scripts and Prime Therapeutics of using a little-known, Switzerland-based company to illegally drive up drug prices and ultimately push those higher costs onto patients.

This collusion, the lawsuit maintained, has been made possible by PBM market consolidation, which has left the three largest PBMs, including Express Scripts, in control of more than 75% of the drug market, and the three next largest in control of much of the rest.
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.