Express Scripts to offer Humira biosimilars
By adding clinically equivalent biosimilars to its formulary, Express Scripts said it can drive greater savings for its clients.
Photo: Jeff Lagasse/Healthcare Finance News
Express Scripts, the pharmacy benefits management business of the Cigna Group's Evernorth, will add three additional biosimilars to its National Preferred Formulary that it said will compete with Humira, the world's top-selling pharmaceutical drug, in terms of competitive net costs. Humira treats inflammatory and pain conditions.
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.
"Embracing biosimilars as they come to market builds on our efforts over the past decade to support greater adoption, just as we did when generics first became available over 30 years ago," he said.
WHAT'S THE IMPACT?
Biosimilar products that Express Scripts will offer on its NPF include Cyltezo, the first interchangeable biosimilar with HUMIRA, low concentration formulation; Adalimumab-adaz, high-concentration formulation, unbranded; and Hyrimoz, high-concentration formulation.
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.
"Our formulary decision process is guided by clinical effectiveness first and foremost, while also considering the needs and continuity of care for patients, in addition to competitive cost savings to our clients," said Harold Carter, chief pharma trade relations officer, Express Scripts. "Our decision to add the Sandoz products, as well as the interchangeable product Cyltezo, to our NPF supports greater affordability across this entire treatment class."
Express Scripts has touted the adoption of biosimilars because it said the resulting competition enables pharmacy benefits strategies that enable greater access and savings for plan sponsors and members.
Preferred formulary placement is one tool to encourage the use of more clinically sound and cost-effective products, including certain biosimilars, the company said. For example, Express Scripts added Semglee, the first FDA-approved interchangeable biosimilar basal insulin, to its NPF beginning in 2022. In doing so, the company estimates more than $20 million savings for plan sponsors in one year.
The biosimilar Amjevita (Amgen), citrate-free, low concentration formulation, is currently preferred on the Express Scripts NPF and the National Preferred Flex Formulary for 2023. Express Scripts will continue to conduct individual reviews of new biosimilar products as they become available, the company said.
THE LARGER TREND
The move comes months 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 maintains, 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.
In marketing its services, Express Scripts touts its ability to leverage its significant market power to extract lower drug prices from drug manufacturers and promises to deliver cost savings to health insurers and employers – a promise that "is knowingly false," the lawsuit said.
Rather, Yost alleged that Express Scripts has used its dominance solely for its own financial gain, creating "a complex 'pay to play' rebate system that, perversely, pushes manufacturers to increase drug prices in order to be placed on, or receive, preferred placement on PBM formularies." The savings that PBMs claim from the inflated list prices are illusory, he said.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
