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Prime to Cover Biosimilars Alongside Humira

Prime to Cover Biosimilars Alongside Humira

A decision is anticipated in early January about which of the now eight Humira biosimilars will be included.

Prime Therapeutics is the latest PBM that will include biosimilars alongside AbbVie’s rheumatoid arthritis drugHumira (adalimumab) on its preferred list of drugs, the NetResults formulary. The PBM has not made a decision about which biosimilars will but included, but a spokesperson said that decision will be made early in 2023.

"Prime actively promotes evidence-based use of biosimilars to deliver the lowest net cost options to clients. In this case, that option may be the brand drug or its competing biosimilars," Dave Schlett, executive vice president and president of PBM solutions for Prime, said in a press release.

Next year, eight biosimilars referencing Humira are expected to be launched, with Amgen’s Amjevita being the first in January. The most recent biosimilar referencing Humira is Fresenius Kabi’s adalimumab biosimilar Idacio, which was approved December 14, 2022. It will be launched after July 2023.

Several other PBMs, including Optum Rx and Express Scripts, have already made decisions to include some of these biosimilars as preferred products alongside Humira. Optum Rx specifically has said they will include Amjevita and two other biosimilars on the Select and Premium formularies. Express Scripts has not yet indicated which of the biosimilars will be included.

Humira is a widely prescribed drug in the United States, with sales of more than $17 billion in 2021 in the Unites States alone. Specialty drug costs, including Humira, represent 2% of prescriptions, yet account for 50% of drug cost spend with continued growth anticipated and are projected to reach $505 billion by 2023. Potential savings related to biosimilars could exceed $100 billion over the next five years.

December 16, 2022

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