CVS Caremark to replace Humira with biosimilars on national commercial formularies
Click Here to Manage Email Alerts
CVS Caremark, one of the nation’s largest pharmacy benefit managers, will remove Humira from its major national commercial formularies effective April 1 in favor of biosimilar options, according to a press release from the company.
However, patients with Choice and Standard Opt Out commercial formulary coverage will still have the option to be treated with originator Humira (adalimumab, AbbVie), the company added.
According to the release, the move will “potentially save our clients more than 50% on adalimumab in 2024 than in 2022,” prior to the availability of any adalimumab biosimilars in the United States.
“We are committed to accelerating the adoption of biosimilars and providing customer choice alongside a seamless member experience,” CVS Caremark President and CVS Health Executive Vice President David Joyner said in the release. “Our customers want to have choices. By preferring biosimilars that have a significantly lower list price than their reference product, CVS Caremark is putting our customers in the driver's seat to best meet the health care needs of their members and lower drug costs.”
CVS Caremark, a subsidiary of CVS Health, has also entered into an agreement with Abbvie to supply Cordavis, another subsidiary of CVS Health, with “a committed volume of co-branded Humira” for the second quarter of 2024, the company said. Launched in August, Cordavis works with drug manufacturers commercialize and co-produce biosimilars for the U.S. market. The subsidiary has already contracted with Sandoz to commercialize and bring to market its biosimilar Hyrimoz (adalimumab-adaz) in the first quarter of 2024 under a Cordavis private label.
A transition protocol featuring text messages and online education will be available for prescribers and patients transitioning from adalimumab to a biosimilar option. Prior authorization for the change will not be required.
“CVS Caremark will meaningfully engage prescribers to guide them through appropriate next steps to help transition plan members,” read the release. “Because current Humira authorizations will be transitioned to the preferred biosimilar products, members and prescribers will not need to obtain a new prior authorization review with this product transition.”
The company added that expanding biosimilar access is “essential” to reducing drug costs and increasing treatment options. According to CVS Health, the U.S. biosimilar is expected to increase from less than $10 billion in 2022 to more than $100 billion by 2029.
However, according to Madelaine A. Feldman, MD, FACR, vice president of advocacy and government affairs at the Coalition of State Rheumatology Organizations, this development represents a conflict of interest given CVS’ partnership with Sandoz.
“These formularies are only offering Sandoz adalimumab biosimilar products,” she said. “They are not offering any of the other manufacturers’ low-priced adalimumab biosimilars.
“In the 1990s the FTC frowned upon manufacturers owning pharmacy benefit managers (PBMs) and allowing them to construct their own formularies,” she added. “The FTC knew that the tendency would be to only offer their own drugs, for coverage, thus reducing competition, which is exactly what the Sandoz/CVS partnership has done.”
Due to the possibility of partnerships like these, FTC in the 1990s required open formularies, wherein the manufacturer had to include all competitors to their product, according to Feldman.
“Although CVS is not directly manufacturing Hyrimoz, they are in partnership with the manufacturer, Sandoz,” she said. “It is no surprise that only Sandoz biosimilars are preferred on the CVS Standard and Advanced Commercial and Chart formularies. This to me smacks of anticompetitive behavior along with a conflict of interest.”
Feldman acknowledged that the “less popular value formularies,” which are offered only to certain populations, do include Hadlima (adalimumab-bwwd; Organon, Samsung Bioepis) with the Sandoz products.
“However, there are up to five and six tiers with this formulary and no way of knowing what tier the competitor will be on,” she said. “This development ultimately opens up another river of profit for CVS.”
References:
CVS Caremark press release:
https://www.prnewswire.com/news-releases/cvs-caremark-accelerates-biosimilars-adoption-through-formulary-changes-302025679.html