Biosimilars adoption: A closer look
Provider and member-centric resources support formulary changes
Michelle Gourdine, MD, Senior Vice President and Chief Medical Officer
In 2023 alone, nine biosimilars launched for Humira, one of the most popular and expensive drugs in the United States used to treat autoimmune conditions. The launch and adoption of biosimilar alternatives can unlock the full potential of these drugs to expand clinically effective treatment options and reduce costs. Earlier this year, CVS Caremark announced efforts to increase biosimilar adoption: As of April 1, 2024, we removed Humira from our major national commercial template formularies; Humira biosimilars are covered.
As this change goes into effect, I want to highlight some of the ways we’re prioritizing the plan member and prescriber experience at every turn.
As a physician, I know transitioning to different treatments due to benefit plan changes might bring up questions and concerns. Many members may be reluctant to change because they’ve been on their specialty medications for years – and may have even tried other medications without success before finding one that works for them. Some might be wondering if the biosimilars can treat their condition because they haven’t heard of them before.
To start, I want to reassure members and prescribers of the clinical effectiveness and quality of the biosimilars we considered as part of this formulary change. When evaluating biosimilars to add to our formulary, we thoughtfully consider a range of factors such as clinical appropriateness, quality, efficacy, and availability to meet the broad range of needs for members who need therapy. We also look at product attributes that might impact their experience taking the treatment such as citrate-free formulation, concentration, and method of administration, to limit gastrointestinal upset and other issues.
Our biosimilars approach is consistent with our broader formulary strategy: providing members coverage of clinically effective medications and helping ensure continuity of care while helping drive lower net costs for payors.
Biosimilars may be a new concept for many, and we’re committed to supporting members and providers as they transition to biosimilar therapies. To that end, we’ve developed robust biosimilars content on CVSSpecialty.com geared towards each audience—with helpful education, videos, credible third-party resources, and answers to commonly asked questions. Members and prescribers are also made aware of formulary changes in advance and connected to these helpful resources through direct mail, text message, email, social, and other channels.
We use technology and our enterprise assets to simplify the prescription change process. For example, we can identify members who may be impacted by formulary changes and proactively message their prescribers. With a single click, prescribers can select the covered biosimilar alternative. The response is electronically sent to the requesting CVS Specialty pharmacy, for a frictionless prescriber and member experience.
Changes like these require many months of coordination, planning, and expertise from multiple teams. As we support our clients and their members through formulary changes, we can maximize the savings potential biosimilars – creating more competition to drive down specialty costs.
