UnitedHealth Group’s pharmacy benefit manager will cover up to three biosimilars that compete with AbbVie’s costly drug Humira next year, the company disclosed Tuesday.
The rheumatoid arthritis treatment is the highest-grossing pharmaceutical of all time and the largest contributor to drug price inflation, according to a congressional investigation. A year-long course of the brand-name biologic drug can cost more than $84,000. Competing versions from other manufacturers will be available for the first time next year, enabling PBMs to pit them against one another for discounts.
By placing biosimilars on the same formulary level as Humira, OptumRx will allow members to continue using the brand-name medicine or switch to a lower-cost alternative. OptumRx is the first PBM to reveal how it plans to deal with the high-cost, brand-name drug when competitors hit the market. AbbVie did not immediately respond to an interview request.
“The coming wave of biosimilars is a pivotal opportunity to reduce cost and increase access to care for millions of people,” OptumRx CEO Heather Cianfrocco said in a statement. The company did not immediately respond to an interview request.
The UnitedHealth Group subsidiary, the third-largest PBM, processed 359 million prescriptions during the third quarter. OptumRx competes with CVS Health’s Caremark and Cigna’s Express Scripts, and the trio collectively covers 80% of insured consumers.
CVS and Cigna did not immediately respond to questions about whether they plan to include Humira substitutes on their formularies. Executives from both companies told investors this month that they expect the introduction of new biosimilars to reduce costs and improve access.
PBMs have anticipated biosimilars for Humira and other brand-name biologics as a way to contain spending, but can face pushback from patients arising from questions about the interchangeability of brand-name biologics and biosimilars.
