Biosimilar adoption helps drive further drop in specialty trend

Earlier this year, we shared that specialty trend had reached its lowest point in recent history in the first quarter of 2024. In the second quarter, we helped rein specialty trend in even further for CVS Caremark clients, driven in large part by our industry-leading approach to biosimilars.

In April, we became the first PBM to remove Humira from our major national commercial template formularies, placing biosimilars for adalimumab in a preferred position. We also proactively engaged with affected members and their prescribers, including using innovative digital tools, to enable a seamless transition and broad adoption.

While specialty utilization increased by 8.2 percent, price growth decreased 6.9 percent – due almost entirely to lower adalimumab unit cost. This dramatic shift demonstrates the value of preferring high-quality, low-cost biosimilars along with a strategy that prioritizes a smooth member and prescriber experience.

When members can afford their medications, they are more likely to adhere to their treatment regimens – and have better health outcomes.¹ That’s why we have long prioritized helping keep out-of-pocket costs affordable.

To that end, we offer flexible plan design options for payors to choose from. We give providers real-time visibility into member cost share information at the point of prescribing. And we proactively share savings advice and alerts with members, empowering them to talk with their providers and pharmacists about cost-effective options.

The results? Out-of-pocket costs for CVS Caremark members have decreased by more than a third from 2016-2023, with the average member paying just $7.26 out-of-pocket for a 30-day supply. With inflation on the mind of many of today’s consumers, we are building our strategies to help ensure their medications stay on budget.

The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted. Adherence results may vary based upon a variety of factors such as plan design, demographics and programs adopted by the plan. Client-specific modeling available upon request. Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan. CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall.​ 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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