Utilization of biosimilars, which are biologic drugs that are highly similar to an already FDA-approved biologic product, will likely continue to increase in 2025. Humira, which first faced biosimilar competition in January 2023, will see extensive competition among biosimilar products. Humira’s global sales once topped $20B annually but dropped to $14.4B in 2023. That number is likely to be much lower for 2024, as PBMs have begun to exclude Humira, including CVS Caremark, who excluded Humira on its major commercial formularies in April of this year.
Other PBMs are following CVS Caremark’s lead and moving to exclude Humira in 2025. Optum will exclude new utilizers in January 2025 but will allow current Humira utilizers to continue treatment with the brand product until sometime later in 2025 (no exact date has been provided yet). Express Scripts has similar plans but is giving clients the option to exclude all utilizers in January or allow current utilizers only to continue with the brand Humira until July 2025. Both strategies will further erode Humira’s market share.
Another strategy that has developed in the biosimilar market involves PBMs partnering with drug manufacturers on private-label products, allowing them to participate in the industry at a new level. We saw this first with CVS Caremark’s partnership with Cordavis on a Humira biosimilar, then Optum’s partnership with Nuvaila, as well as Express Scripts’ partnership with Quallent Pharmaceuticals. Many were concerned with the idea of a PBM being involved in the manufacturing and/ or distribution of a drug, but this strategy seems to allow for patient savings opportunities that many feared would disappear with biosimilar products in the form of copay assistance.
With many more brand biologic drugs losing patent protection in the coming years, this particular strategy seems to be gaining in popularity. In fact, Express Scripts and Optum have both announced plans to offer a biosimilar version of Stelara at $0 for eligible patients in early 2025 through their partnerships with Quallent and Nuvaila, respectively. NFP’s Rx Solutions will continue to monitor the biosimilar market in 2025, as we have in the past, and will work with our clients on additional strategies that can promote early adoption of these low-cost alternatives to expensive biologic products.
Sources:
- Tristan Manalac. “AbbVie’s Humira Continues to Lose Market Share as Biosimilars Gain Ground: Report,” BioSpace, 2024.
- Paige Minemyer. “Evernorth’s Accredo to Make Stelara Biosimilar Available at $0 Out-Of-Pocket,” Fierce Healthcare, 2024.
- Angela Maas. “Optum Subsidiary Nuvaila Will Offer Biosimilars of Stelara, Humira,” MMIT, 2024.