CVS announced that effective 4/1/24, Humira will be removed from their standard national commercial formularies in an effort to expand the adoption of recently approved Humira biosimilars. Humira has topped the list of drug expenditures for the past several years, bolstered by approval for nine indications ranging from Rheumatoid Arthritis, Ulcerative Colitis, Crohn’s Disease, and Psoriasis, to name a few. Throughout 2023, several biosimilar products were launched to compete with Humira more directly and reduce overall costs. A few notes on biosimilars: By technical definition, a biosimilar product is a biologic medication that is highly similar to another biologic that has already been approved by the FDA (in this case, Humira). Currently, most biosimilar products are still classified and would be covered under the benefit as a brand drug. Other companies may market a biosimilar product once the patent expires on the originator product, similar to marketing a generic medication. Availability of biosimilar products should create competition between manufacturers and result in reduced overall costs. To date, conversion to Humira biosimilars has been slow (<5% of utilization has shifted) due in part to biosimilar products having the same formulary status as Humira and lack of financial incentive for a patient to move to the biosimilar since they would still be paying the brand/specialty copay/coinsurance. Additional uptake of biosimilars and resulting client cost savings will largely be driven by the formulary status of Humira, patient out-of-pocket expenses, and provider comfort utilizing a biosimilar medication.
Most carriers and PBMs have added at least one biosimilar product to formulary but have kept Humira in a preferred formulary status as well. CVS will be the first major PBM to remove Humira from formulary.
An added note regarding the press release is that CVS also announced they entered into an agreement with AbbVie, the maker of Humira, to supply Cordavis with a “committed volume” of co-branded Humira. Cordavis is a CVS Health company that works directly with manufacturers to commercialize and/or co-produce biosimilar products. Upon the announcement of Cordavis in August 2023, it was communicated that the first product being brought to market would be Hyrimoz. Cordavis contracted with Sandoz to commercialize and bring Hyrimoz to market, which is also a biosimilar to Humira and is preferred across CVS formularies. In this manner, CVS Health companies have a hand in producing, supplying, and dispensing biosimilars to Humira.
What’s next?
CVS will begin to contact impacted patients and providers 60 days prior to the change, as well as provide follow-up communication and online education. Patients with an active Humira prior authorization will not need to obtain a new authorization for a preferred biosimilar product. Providers will also be guided through the necessary steps to transition patients to a preferred biosimilar product.
Dr. Jeff Eichholz is the Director of Pharmacy Solutions for McGohan Brabender. If you have a question or topic you would like addressed, you can email him at jeichholz@mbbenefits.com.