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OptumRx to Cover Amgen’s Biosimilar of Humira


OptumRx will offer Amjevita and two other biosimilars alongside Humira. OptumRx is the first PBM to make public its plans for the seven Humira biosimilars that could be introduced in 2023.

Beginning in 2023, OptumRx plans to include on its formularies Amgen’s Amjevita, a biosimilar of AbbVie’s blockbuster rheumatoid arthritis drug Humira (adalimumab), as well as two additional biosimilars, chief executive officer Heather Cianfrocco announced at a session of the recent HLTH2022.

Heather Cianfrocco

Heather Cianfrocco

“The coming wave of biosimilars is a pivotal opportunity to reduce cost and increase access to care for millions of people,” she said in a statement. “OptumRx fully supports advancement of the biosimilar market as part of our commitment to providing patients and providers with high quality and affordable care, flexibility, and choice.”

The new biosimilars will be available on the Select and Premium formularies, according to a company spokesperson. No information has been provided on tiering or utilization management strategies that could be employed.

Humira is a widely prescribed drug, with worldwide sales of more than $20 billion in 2021. Specialty drug costs, including Humira, represent 2% of prescriptions, yet account for 50% of drug cost spend with continued growth anticipated and are projected to reach $505 billion by 2023. Potential savings related to biosimilars could exceed $100 billion over the next five years.

Next year, seven biosimilars are expected to be launched, with Amjevita being the first in January. The others expected to launch in the second half of the year include: Organon's Hadlima, Boehringer Ingelheim’s Cyltezo, Coherus BioSciences’ Yusimry, Viatris’ Hulio, Sandoz’ Hyrimoz, and Pfizer’s Abrilada.

OptumRx leaders said they estimate double-digit client net cost improvement in 2023 compared with 2022 as a result of the Humira biosimilars. “Our independent pharmacy & therapeutics committee has reviewed all the FDA-approved biosimilars to maintain clinical quality of care,” the company said in a statement. “Biosimilars added at parity will optimize patient, provider, and client choice and flexibility.”

Related: How will the Humira Biosimilars be Covered?

OptumRx is the first PBM to make public its plans for the Humira biosimilars. Prime Therapeutics has not made a decision yet, according to a spokesperson.

CVS Caremark has not made a specific decision on which biosimilar or biosimilars will be included on the formulary, but a spokesperson said maximizing value will be a priority. “With so many entrants to market in 2023, we expect the biosimilars category to be increasingly competitive and dynamic,” the CVS spokesperson said. “These agents differ in a number of ways — formulation, concentration, potential supply constraints, administration devices, price and the availability of copay assistance programs, to name a few — and all will be part of our thoughtful decision-making.”

Express Scripts has not responded to requests about how they will be handling the Humira biosimilars.

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