Specialty is still a major cost driver for clients and biosimilars represent one of the biggest opportunities for reducing drug costs. Biosimilars have no clinically meaningful differences from the original biologic (or reference product). Like generics, biosimilars may cost less. But lower cost doesn't mean they're not safe or effective. Biosimilars have transformed the pharmacy landscape and have lived up to their promise of increased affordability and accessibility. CVS Caremark led the market by becoming the first pharmacy benefit manager (PBM) to remove Humira® from our major national commercial template formularies, preferring biosimilars instead. Based on the success of these formulary changes, we're now seeing the market move to lower cost, clinically appropriate alternatives. In April 2024 alone, we drove more biosimilar prescriptions than the entire industry did in 2023.
Humira biosimilar transition success
Our biosimilar formulary strategy to date has helped clients and their members realize $1.5B in gross savings.1 Supporting the adoption of biosimilars is critical to increasing competition and lowering specialty drug costs while improving member affordability.
Given the success of our Humira biosimilar strategy and rollout, we’re using those learnings to introduce two new preferred Stelara® biosimilars, while keeping Stelara on our formularies to make sure members have a consistent supply of available options.
We're maximizing value for members and clients by:
- Leveraging competition and our vast negotiation experience to achieve low net cost for clients
- Offering innovative plan design options to lower member costs
- Creating personalized member and prescriber outreach
- Introducing formulary optionality, including low list price strategies, moving the market away from its reliance on rebates
With each entrant, we'll evaluate cost and clinical considerations, including formulation, delivery mechanism, supply and member experience. We'll continue to use this evaluation framework to thoughtfully evaluate Stelara against each new competitor, keeping clients informed every step of the way.
Unlock substantial savings with our expertly crafted formulary strategy.
Your members are at the heart of what we do
-
1 P1017640325. CVS Health Analytics, 2024. CVS Commercial clients Jan 2024 – Dec 2024.
-
2 P1017770425. CVS Health Analytics, 2024. CVS Commercial clients Apr 2024 – Dec 2024.
-
3 P1017780525. Approximately 86% of preferred biosimilar utilizing members had an out-of-pocket cost of $0 from April 1, 2024 – December 31, 2024.
All data sharing complies with applicable law, our information firewall and any applicable contractual limitations. Savings projections are based on CVS Caremark data. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors.
This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health.