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      Bold biosimilars strategy nets success

      Scripts for Humira biosimilars soar in just weeks

       

      Joshua Fredell, Vice President & Head of PBM & Specialty Product Innovation

      Briefing

      On April 1, 2024, CVS Caremark removed Humira from our major national commercial template formularies, placing biosimilars including Hyrimoz in a preferred position. We are the first – and so far, the only – PBM to do so.

      In just a few short weeks, the results of this bold move are evident:

       

      97% of scripts for adalimumab filled with a preferred biosimilar1

       

      Through actions such as this, we are demonstrating our commitment to redesign the pharmaceutical landscape and help clients and members realize savings by increasing biosimilar adoption.

      The success of the shift shows the power of our integrated enterprise assets to educate and lead the market. In the months before the formulary change went into effect, we prioritized plan member and prescriber experience at every turn. We assured providers of the clinical effectiveness and quality of the biosimilars we considered. And we assured them that our biosimilars approach is consistent with our broader formulary strategy: helping drive lower net costs for payors without sacrificing coverage of clinically effective medications or continuity of care. Through our connected model, RxChange technology makes it simple for providers to consider the covered alternatives to Humira and make the change with a single click.

      Members were also notified digitally of the upcoming coverage change. To optimize their experience, no action was required on their part. To strengthen comprehension and enhance trust in our decision, the message included a link to an educational video on biosimilars.

       

      $0 out-of-pocket cost2

       

      Last but most important, we fulfilled our commitment to deliver savings without compromising care. Clients who remained on the standard commercial template formulary (98 percent) have already realized significant cost savings.

       

      $908M client gross savings3

       

      These results highlight CVS Caremark’s unique ability to move the market to lower cost, clinically appropriate alternatives. We will continue to leverage the power of our integrated CVS Health approach to support clients, members, and providers through this formulary change and other market innovations to come.

       

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      • 1 As of May 25, 2024. Adalimumab includes: HUMIRA, HYRIMOZ, HADLIMA, ADALIMUMAB-ADAZ, AMJEVITA, ADALIMUMAB-AACF (2 PEN), HULIO, ADALIMUMAB-FKJP, IDACIO, YUFLYMA, ADALIMUMAB-ADBM, and CYLTEZO. 

      • 2 Enrolled in a plan’s standard template formulary with intelligent benefit design. As of May 25, 82% members had $0 copay.

      • 3 May’s gross cost is pro-rated to full month based on what we observed through May 25. CVS Health Commercial Book of Business clients with standard template formularies (i.e., ACSF, Value, SCF, and BCF), excluding restricted clients. PBM Analytics, May 2024.

       

      For most plans, with pharmaceutical manufacturer copay assistance coupon.

      All data is from CVS Health Analytics, 2024. CVS Commercial clients January 2024 – May 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.