The dynamic biosimilars market

Biosimilars are disrupting the market and helping drive down cost for providers, payors, and members. At CVS Health, we use competition in a therapy class to help drive a low net cost strategy for clients. With a low net cost strategy, the coverage decision may be based not only on the price of one drug versus another, but also how effectively utilization can change between them. For biosimilars, this will likely be a combination of the reference product, biosimilar competitors, and other branded products.

In addition to the power of competition, the dynamic biosimilar market is about making clinically safe, effective medications available for members who have been on a medication therapy for a long time with no other options.

Josh Fredell and Jackie Mancini discuss how biosimilars are likely to drive savings for plan sponsors in the autoimmune category.

Where we’ve been, where we are, and where we're headed

Amgen’s Amjevita, launched in January, has been added as a non-preferred specialty product on our commercial template formularies. This provides patients and providers with options while our strategy remains flexible for other biosimilars entering the market in the next 12 months.

Marketplace dynamics influence how each new product is evaluated at launch. We use three criteria to navigate this: clinical appropriateness and efficacy, product attributes and availability, and price.

These are important considerations as not all Humira biosimilars are created equally, with differences in the design of the delivery device, high or low concentration levels, and other features that can impact member experiences. For Humira patients with rheumatoid arthritis, a push button or autoinjector affects the ease and usefulness of a medication.

What’s ahead: Currently, there are 26 biosimilars on the market available for doctors to prescribe and for members to use. That number will grow quickly as we move through this year and into 2024. In fact, seven new Humira competitors are expected to launch in July 2023 alone.

However, it’s important to look beyond Humira to the entire autoimmune category. Autoimmune conditions such as psoriasis and rheumatoid arthritis are the number one driver of spend for plan sponsors. As the best partner to manage pharmacy benefits, we remain focused on helping our clients maximize economic opportunities in the autoimmune category and minimize member disruption when making decisions about biosimilars.