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For the first time in April, biosimilars started to gain a larger share of the Humira market. Up until that point, the market felt unimpeachable, with AbbVie’s Humira retaining 96% of the share by February. That changed when Humira came off the formulary of CVS Health’s pharmacy benefit manager Caremark.
So far, Caremark remains the only major PBM to remove Humira from its formulary, though others like Cigna have taken steps to increase biosimilar use.
New prescriptions for Hyrimoz, the main biosimilar version CVS included on its formulary, jumped in the month of April, accounting for about a third of new prescriptions each week, according to IQVIA data pulled by Evercore analyst Elizabeth Anderson. As of the end of April, biosimilars made up about 15% of the total prescriptions in the Humira and biosimilars market, Anderson said.
Joshua FredellJoshua Fredell, Caremark’s vice president and head of PBM and specialty product, told Endpoints News in an interview that Caremark began testing out biosimilar versions of Humira on its formulary at the start of 2023. But because the biosimilars weren’t in a preferred position on the formulary, they weren’t chosen over Humira. That didn’t change, even when some biosimilars became preferred in September.
“There needs to be a bigger catalyst for the change,” Fredell said.
Fredell said he expects to see other PBMs take the leap to increase biosimilar adoption by taking Humira off their formularies.
“I think other PBMs will face competitive pressures that we’ve created. It’s part of our job to create competitive pressures in the market with our competitors,” Fredell said. “And I hope they do feel that pressure, of ‘Why not make a similar move?’”
Fredell said that to make the formulary switch that removed Humira work, Caremark had to find biosimilars that would be able to replace most forms of the medication. Caremark’s formulary includes Sandoz’s biosimilar Hyrimoz as well as another Sandoz product, CVS-owned Cordavis’ private-label version of Hyrimoz, and Organon’s Hadlima.
By picking biosimilars that complement what the majority of patients are using, the switch from branded Humira should in turn lead to savings for Caremark’s employer clients, he said. That might not have worked if only a certain percentage had switched over to a cheaper list price medication. In that instance, a majority might still be on Humira, leading to minimal savings. Fredell said Caremark looked for biosimilars that matched the formats of medications people taking Humira were using, like low and high concentrations, and options like prefilled syringes and auto-injectors.
“When you look at the biosimilar market for Humira, while there’s less than nine or 10 biosimilars in the market, there’s really only about three or so where you have coverage of all of those attributes really well,” Fredell said.
Gaining traction
In the month of April, most of the traction in the biosimilars market came from people switching off of Humira, rather than people starting new prescriptions going directly to the biosimilar, Fredell said.
“Far and away, the utilization we’re seeing now is coming because of the change,” Fredell said, referring to the removal of Humira from the formulary at the start of the month. Only about 4% of Caremark’s clients opted to keep Humira on their formularies, he said.
A month in, Fredell said there hasn’t been much pushback from patients or doctors wanting to stay on Humira. So far, about 93% of people using the autoimmune medication are using a biosimilar version, a percentage Fredell expects to increase by the end of May.
In one month, Caremark clients have already seen $140 million lower gross costs, not accounting for rebates, Fredell said.
Fredell said he expects the foothold biosimilars gained in the Humira market will stick around, though it remains to be seen how AbbVie responds to the changes. It’s possible AbbVie could update Humira’s list price or take other approaches to regain market share. And other biosimilar manufacturers may change their list prices too, or leave the market entirely, which could influence how the market looks in 2025.