Some PBMs will offer Amgen’s Amjevita biosimilar as a preferred product alongside Humira, but CVS Caremark said Humira will remain preferred and Amjevita will be placed on a non-preferred brand tier.
Amgen has launched the first of the highly anticipated biosimilars of AbbVie’s blockbuster arthritis/anti-inflammatory drug Humira (adalimumab). Amgen is making Amjevita (adalimumab-atto) available with two pricing options. The first is a 5% below the current Humira price of $6,922 for a four-week supply. The second would be 55% below the current Humira list price.
“Biosimilars are extensively studied, FDA-approved treatments that have the potential to reduce costs to the healthcare system,” said Steven Taylor, president and chief executive officer at the Arthritis Foundation, said in a press release. “Amjevita provides another treatment option for patients and their doctors.”
While Amgen wouldn’t provide specifics about the two pricing programs, it’s likely that the program with the 5% discount off Humira will provide higher rebates. “For some entities in the system, the financial considerations mean a higher list price may allow for broader access for patients,” an Amgen spokesperson told Formulary Watch. “Each entity can choose the list price that works best for the patients they serve.”
The Amgen spokesperson said the company is pursuing broad coverage across commercial, Medicare and Medicaid plans, and eligible commercially insured patients may pay as little as $0 per month with the Amjevita SupportPlus Co-Pay Program.
Humira is a widely prescribed drug in the United States, with sales of more than $17 billion in 2021 in the Unites States alone. Eight biosimilars referencing Humira have been approved. The most recent is Fresenius Kabi’s Idacio, which was approved in December 2022. Amgen’s Amjevita is the first to be launched and the others will follow in second half of the year, including: Organon’s Hadlima, Boehringer Ingelheim’s Cyltezo, Coherus BioSciences’ Yusimry, Viatris’ Hulio, Sandoz’ Hyrimoz, and Pfizer’s Abrilada.
Several PBMs — including Optum Rx, Express Scripts and Prime Therapeutics — have already indicated they will include some of these biosimilars as preferred products alongside Humira.
A spokesperson from Prime, however, said it is not adding Amjevita at this time and has no further updates. A CVS Caremark spokesperson indicated that Humira will remain preferred and Amjevita will be placed on a non-preferred brand tier. Beginning Feb. 1, it will cover Amjevita on its commercial template formularies.
“We believe this approach provides coverage for members who choose to access the biosimilar, but provides flexibility to continue to evolve our formulary strategy and minimize member disruption as additional biosimilars launch beginning in July,” the spokesperson told Formulary Watch. “We will continue to use our evaluation framework to thoughtfully evaluate both Humira and Amjevita against each new competitor and we will keep our clients informed every step of the way. Over the next two years, we expect our clients to benefit from significant savings in the autoimmune categories where biosimilar competition exists.”
Express Scripts has indicated that it will add biosimilars to its largest formularies as preferred products to treat inflammatory conditions, but the PBM hasn’t decided yet which of the Humira biosimilars it will add. The company has said in the past that it has advocated for the adoption of biosimilars. For example, Express Scripts added Viatris’ Semglee, the first FDA-approved interchangeable biosimilar basal insulin to improve glycemic control in adults and pediatric patients with type 1 diabetes and in adults with type 2 diabetes, to its national preferred formulary beginning in 2022. The company estimates this saved more than $20 million for plan sponsors in one year.
Optum Rx has said they will include Amjevita and two other biosimilars on the Select and Premium formularies. An Optum Rx spokesperson said that beginning February 1, clients can include both Amjevita list price options on the commercial formulary. "This approach delivers choice to our clients, consumers and providers while encouraging increased competition, which results in lower costs in this important and high-spend drug class," the spokesperson said. In a statement, Optum Rx indicated they expect to see double-digit client net cost improvement in 2023 vs. 2022 alone.
Prime has said it will include some of the biosimilars on its preferred list of drugs, the NetResults formulary, but has not made a decision about which ones.
A spokesperson for the Centers for Medicare and Medicare Services said that Amjevita and the additional Humira biosimilars will be considered Medicare Part D drugs if used for a medically accepted indication and may be included on a plan’s formulary. But since Amjevita just launched, CMS will have a better sense of Part D formulary coverage after the March 2023 formulary submission window.
Last year, the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services in reported indicated that increased use of biosimilars could reduce Medicare Part D spending by 18% and beneficiaries’ out-of-pocket costs by 12%.
This story has been updated to include additional information from Optum Rx and from CMS.