As health care costs continue to increase, biosimilar drugs are gaining traction as a clinically equivalent alternative to high-cost biologics, delivering health plans an option to reduce specialty costs and providing patients with a more affordable treatment option. Biosimilars are to biologics, what generics are to brand-name drugs. Biologics spending is increasing 12.5% annually on average over the last five years and are now comprising 46% of spending.¹ 

To best support this changing landscape and the diverse needs of health plans and members, Prime Therapeutics LLC (Prime) utilizes a comprehensive biologic and biosimilar management strategy, centered around client optionality. 

With our conflict-free approach, we are not requiring our plans to adopt or exclude specific biosimilars. We can truly meet clients where they are. We will continue to address each biosimilar as they are approved and enter the market to make decisions that create sustainable success for those we serve and any unintended shifts in costs to consumers. 

Prime has long supported biosimilars, beginning with the first pharmacy benefit interchangeable insulin biosimilar, insulin glargine (Semglee^®). Each biosimilar developed is unique and requires a nuanced evaluation of safety, efficacy, cost and client circumstance to determine the appropriate formulary strategy for employers and members. 

Prime’s Stelara^® approach offers clients savings 

Prime continues to champion the use of biosimilars with the introduction of Stelara biosimilars Selarsdi™, Steqeyma^® and Yesinteck™ in July. More than 10 million Prime member lives will be moving to Stelara biosimilars, which will save clients up to 87% off the list price of Stelara. In total, Prime’s biosimilar strategy has saved clients over $2 billion.² 

For Prime’s NetResults™ F and Health Information Exchange (HIM) formularies, the biosimilars will be preferred and Stelara will be removed from formulary. However, for Accord and NetResults A formularies, Stelara and its biosimilars will be offered in parity. Flexibility in providing multiple biosimilar options delivers the best potential for higher member adoption. 

Through clinical expertise, expert and predictive analysis and customization, Prime helps guide formulary building and coverage decisions with, and on behalf of, its clients. Visit PrimeTherapeutics.com/Biosimilars to learn more about Prime’s evidence-based approach.  

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References

1.  Biosimilars in the United States 2023-2027. (n.d.). IQVIA. https://www.iqvia.com/insights/the-iqvia-institute/reports/biosimilars-in-the-united-states-2023-2027 
2. Prime internal data