Prime Therapeutics sets forth new formulary recommendations to increase affordability with several new Humira® biosimilars

Formulary design recommendations help create competition to drive savings, provide optionality to meet unique client needs

July 12, 2023

EAGAN, Minn. – Prime Therapeutics LLC (Prime), a pharmacy benefit manager (PBM) serving nearly 38 million members nationally today announced its new 2023 Humira® formulary recommendations. Prime believes strategic use of biosimilars to deliver low net cost options to clients will allow for an increase in manufacturer competition and potential savings on both Humira® and its biosimilar options.

Humira®, a biologic drug used to treat inflammatory conditions, has been the world’s top selling drug from 2012 to 2020; in 2021 it was second only to a COVID-19 vaccine. The first four of nine Humira® biosimilar options coming to market in 2023 launched on July 1 in different versions (formulations and means of delivery) and at various price points.

Biosimilars are FDA-approved copies of biologic drugs that have been shown to be highly similar to the original (originator or reference) drug in terms of safety, efficacy and quality. Though biosimilars are newer to the market, they are typically less expensive for members than the original biologic. In fact, the American Journal of Managed Care estimates that we could see up to $124.5 billion in savings through 2025 from adoption and use of all biosimilar products, including the Humira® biosimilars.1

A flood of new Humira® biosimilars are expected to bring competition to a market that has been dominated by this branded drug, like how generic drugs have created competition for traditional drugs once their patents expire. Similar to what was seen with the generic innovation wave, Prime believes education will be critical to biosimilar adoption – for providers to pharmacists to members. Already in the provider space, 85% of participating rheumatologists said educating patients about biosimilars is important.2

Emily Colaizy, assistant vice president, pharmaceutical trade relations for Prime, said “Biosimilars offer a more affordable and widely available alternative to Humira®, which could help to improve access to this potentially lifesaving therapy. As leaders in next-generation pharmacy solutions, we’re intent on offering our clients options to deliver significant savings for clients and members while ensuring members have access to clinically safe and effective therapies.”

2023 strategy and formulary recommendations

Prime will recommend two formulary strategies for commercial formularies which will include the originator, Humira®, and two of its biosimilars so plans can choose the approach that is best for their members. Prime clients may also choose to deviate from the standard recommendation and customize their formularies. In this way, Prime offers optionality based on the biosimilar market and clients’ unique needs. Further, coverage of Humira® and these biosimilars provides members with greater choice to help ensure they, along with their provider, can make appropriate care decisions.

Prime is providing recommendations to commercial clients that include coverage of the following biosimilars:

  1. Amjevita™ (Amgen, low concentration) and Cyltezo® (Boehringer Ingelheim, interchangeable, low concentration); or
  2. Amjevita™ (Amgen, low concentration) and Hadlima™ (Organon / Samsung Bioepis, high and low concentration)

Prime is also recommending coverage of Cyltezo® (Boehringer Ingelheim, interchangeable, low concentration) for Medicare Part D formularies.

While the current industry focus is on the 2023 Humira® biosimilars, there is an increasing number of biosimilar products expected over the next decade, for which Prime will help clients prepare and manage.

As part of its total drug management strategy, Prime supports evidence-based use of FDA-approved biosimilars. And it will continue to monitor the Humira® biosimilars pipeline to make future recommendations designed to accommodate market access and client needs. Follow how Prime continues to innovate in the biosimilar space.

1. Projected US Savings from Biosimilars. The American Journal of Managed Care. July 2022, Volume 28, Issue 7.
2. 2023 Biosimilars Report. CardinalHealth.

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