Biosimilars
Strategies that expand the adoption of biosimilars to lower specialty costs
Biosimilars are living up to their promise of increased affordability and accessibility. After our bold formulary change in April 2024 to remove Humira and prefer a low-list price biosimilar, we’re 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. You can count on CVS Caremark to guide you through this with confidence.
The key to maximizing the savings potential of biosimilars: achieving low net cost and adoption, with our proven formulary strategy. Our multifaceted and proven approach includes intelligent purchasing, utilization management, supporting provider acceptance and member education.
Clients can take advantage of flexible preferred drug strategies including:
- Biosimilars-first: Maximize competition
- Expanded use of biosimilars within key high-spend classes
- Helps lower overall costs with clinical policy support and provider engagement
- Core strategy: Drive to an overall low cost
- Achieve immediate savings, by class, through a mix of brand and biosimilars
- Monitoring and review done quarterly aligns with market factors and overall cost savings
Evaluating newly available products for formulary placement is complex. Key considerations for preferring a reference brand or biosimilar include:
- Product attributes
- Ability to meet demand
- Drug delivery system
- Pricing strategy
$500M gross savings for clients 1
97% adoption of low cost preferred biosimilars 2
$0 out-of-pocket cost for members utilizing preferred biosimilar 3
A vibrant biosimilars market to drive savings: 5 things you should know
Here are 5 things you should know about how biosimilar competition can help drive low net cost for payors
Unlock substantial savings with our expertly crafted formulary strategy and smooth transition to biosimilars.
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1 CVS Health Analytics, 2024. CVS Commercial clients Jan 2024 – Jun 2024.
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2 Ibid.
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3 Approximately 83% of preferred biosimilar utilizing members had an out-of-pocket cost of $0 from April 1, 2024 – June 15, 2024. CVS Health Analytics, 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.