HLTH22: Optum to add biosimilars to formulary to tackle the massive cost of Humira

Biosimilar
HLTH22: Optum to add biosimilars to formulary to tackle the massive cost of Humira
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Source: FierceHealthcare
Optum Rx expects Humira biosimilars to have an almost immediate impact on specialty drug spend.
LAS VEGAS—Optum Rx is planning to add up to three biosimilar drugs to its formulary to compete directly with AbbVie's Humira, which accounts for massive pharmacy spend each year.
Optum Rx, the pharmacy benefit management subsidiary of UnitedHealth Group, manages more than 66 million members and is one of the three largest PBMs that dominate the market, alongside CVS Health's Caremark and Cigna's Express Scripts.
The company said it will place those biosimilars on its formulary at parity with Humira, meaning they'll be on the same tier. The first biosimilar to compete with Humira will arrive next year and will be the first added to the formulary.
The goal, CEO Heather Cianfrocco said at a HLTH session Tuesday, is to make a dent in rising specialty drug costs, which represent just 2% of prescriptions but 50% of costs. Optum Rx said Humira alone accounts for $20 billion in sales each year.
PBMS have circled the launch of biosimilar drugs as a crucial step in addressing specialty spend, as they bring greater competition into the pharmaceutical market. Biosimilars in competition with Humira in particular have been long awaited.
"Those are our opportunities to not just address affordability of drugs, one of the largest, again, drivers of healthcare costs for clients and payers, but also to get at the root of drug costs for patients and for our consumers," she said.
Optum Rx said it estimates clients could see double-digit net cost improvement in 2023 compared to 2022, with savings compounding over time. Looking beyond Optum and Humira, the potential savings across the industry thanks to biosimilars could top $100 billion over the next five years.
In addition to the potential for cost savings, Optum said adding biosimilar products to its formulary offers greater choice for patients without hindering their access to high-quality therapies. This decision, the PBM said, builds on recent announcements on affordability, such as its decision to eliminate cost-sharing for eligible members for five key drugs, including insulin.
Cianfrocco said the Optum Rx team "worked really hard" in making this formulary determination. All Food and Drug Administration-approved biosimilars are reviewed by Optum's independent pharmacy and therapeutics committee before formulary decisions move forward to ensure a high standard of clinical efficacy.
"I think that this is just a step," she said. "There is more to be done."
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