Biosimilar adoption achieves $908 million in gross savings
Momentum steady for biosimilars market months after CVS Caremark formulary change
Joshua Fredell, Vice President & Head of PBM & Specialty Product Innovation
In April, we removed Humira from our major national commercial template formularies. This bold move, which improves access to lower-cost, clinically appropriate medicines, comes at $0 out-of-pocket cost1 for eligible members using the preferred biosimilar. Six months later, clients have realized $908 million in gross savings.2
The market is seeing a shift toward biosimilar drugs to reduce costs – and it’s working. Biosimilar competition has saved patients $15 billion from 2019-2023, according to a recent report from the Pacific Research Institute. As the authors note, increased competition for reference products like Humira, Stelara, and Enbrel will drive even more savings.
CVS Caremark, CVS Specialty, and manufacturers working together made it possible to deliver significant savings without compromising care.
The right formulary approach
Cost management tools and engagement
Secure competitive pricing
Monitor and manage pipeline
A vibrant biosimilars market, with the right products and right attributes, will help provide affordable options for members and choice for payors.
Advanced technology, better experiences
Optimize process with digital tools
Digital innovation and our enterprise assets help simplify the prescription change process and support ongoing care
Personalized touchpoints informed by data
Proactively notify prescribers of formulary changes and provide covered options tailored to each member’s plan
Improved prescriber-member communication
Providers can make prescription changes electronically with ease and efficiency, ensuring no surprises or guesswork
Acceptance and adoption of biosimilar drugs is key to maximizing their savings potential. Our connections made the prescription change process easier for providers and members. That’s how we drove more biosimilar prescriptions in April 2024 than the entire industry delivered in 2023.
Plan sponsors can count on us to ensure providers and members are informed about new biosimilars and that members receive clinically safe, effective medications.
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1 Enrolled in a plan’s standard template formulary with intelligent benefit design. As of September 15, 85% members had $0 copay.
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2 CVS Health Analytics, 2024. CVS Commercial Book of Business clients with standard template formularies (i.e., ACSF, Value, SCF, and BCF), excluding restricted clients, January 2024 – September 2024. All data sharing complies with applicable law, our information firewall and any applicable contractual limitations. Gross 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. $0 out-of-pocket costs for members enrolled in a plan’s standard template formulary with intelligent benefit design.
This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health.
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