Evernorth making Stelara biosimilar available for $0 out-of-pocket

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Evernorth Health Services, a subsidiary of Cigna, plans to have a Stelara biosimilar available for $0 out-of-pocket cost for eligible patients of its specialty pharmacy, Accredo, beginning in early 2025.

The interchangeable biosimilar will be produced for Evernorth's affiliate private label distributor, Quallent Pharmaceuticals, and will be available at $0 out-of-pocket for most patients through Quallent's copay assistance program.

The program is expected to save individual patients around $4,000 on average per year, according to Evernorth.

WHAT'S THE IMPACT?

The biosimilar price will be more than 80% lower than the list price of Stelara, according to Evernorth, which could represent notable savings for employers, unions, municipalities and other sponsors that work with Accredo as part of their specialty pharmacy network offering.

More than 30,000 Accredo patients currently use Stelara, 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, 24/7, the company said.

"We continue to believe in the power of biosimilars to achieve significant savings for patients and plan sponsors now and into the future," said Matt Perlberg, president of Evernorth Health Services' pharmacy and care delivery businesses. "We're already seeing strong interest in the Humira biosimilar made available to Accredo patients in June, and now we're focused on improving affordability and access to another widely used, high-cost treatment for a variety of inflammatory conditions. We are uniquely positioned to lower costs because of the leading capabilities we have in navigating the supply chain as well as the clinical expertise to help achieve the best patient health outcomes."

THE LARGER TREND

In June, Evernorth made an interchangeable Humira biosimilar available, and more than 25% of eligible Accredo patients are now using the biosimilar, the organization said.

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.

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.

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