Optum Rx Prioritizes Biosimilars Now
UnitedHealth Group’s Optum Rx, one of the largest pharmacy benefit managers (PBMs) in the U.S., is taking a significant step in its ongoing effort to reduce prescription drug costs. According to a recent report by Reuters, Optum Rx will remove the popular arthritis drug Humira from some of its preferred formularies starting January 1, 2025. Instead, the PBM will recommend biosimilars, which are cheaper alternatives to Humira, as the preferred options for patients.
This decision aligns Optum Rx with other major PBMs like CVS Caremark and Cigna’s Express Scripts, both of which have recently taken similar actions in favor of biosimilars. The shift represents a broader industry trend to promote the use of biosimilars to reduce costs associated with high-priced branded drugs.
Overview of Humira and Its Biosimilars
Humira (adalimumab) is one of the most widely used biologic drugs in the U.S., commonly prescribed to treat conditions such as rheumatoid arthritis, Crohn’s disease, and psoriasis. However, its high price tag has made it a target for cost-saving initiatives by healthcare organizations and PBMs alike.
Biosimilars are nearly identical copies of biologic drugs like Humira, developed to offer the same therapeutic benefits at a fraction of the cost. These alternatives provide an opportunity for patients and healthcare providers to access life-saving treatments without the financial burden associated with branded medications.
Optum Rx’s Decision to Remove Humira from Preferred Formularies
Beginning in 2025, Optum Rx will remove Humira from some of its preferred formularies, replacing it with cheaper biosimilar options. This move is part of a growing industry trend where PBMs are prioritizing the inclusion of biosimilars on their formularies to combat rising drug prices. Optum Rx’s decision follows similar steps taken by other major PBMs in the U.S., including CVS Caremark and Cigna’s Express Scripts.
According to the report from Reuters, Optum Rx will continue to cover Humira until the biosimilars receive an interchangeable designation from the Food and Drug Administration (FDA), which is anticipated to occur in 2025. This means that for now, patients who prefer Humira can still access the drug through Optum Rx’s coverage, though it will not be the preferred option on the formulary.
Biosimilars as Cost-Saving Solutions
Amgen’s Amjevita as the Preferred Option
As of January 2025, Amgen’s Amjevita will be one of the biosimilars replacing Humira on Optum Rx’s preferred formularies. Amjevita has been recognized as a highly effective biosimilar with nearly identical clinical outcomes to Humira, making it a viable and cost-effective alternative for patients. By prioritizing Amjevita and other biosimilars, Optum Rx aims to reduce healthcare costs while maintaining high-quality care for patients.
CVS Caremark and Cigna’s Similar Actions
In April 2024, CVS Health’s Caremark announced a similar plan to remove Humira from its preferred formularies, followed by Cigna’s Express Scripts in August 2024. Since removing Humira from their formularies, both companies have seen a spike in prescriptions for Sandoz’s Hyrimoz, another biosimilar to Humira. This trend highlights the growing acceptance of biosimilars among healthcare providers and patients alike.
Pharmacy benefit managers have increasingly emphasized the role of biosimilars in their strategies to lower drug costs, especially for high-priced drugs like Humira. The decision to remove Humira from formularies is seen as a critical step toward making healthcare more affordable for millions of patients.
The Impact of FDA’s Interchangeable Designation
The FDA’s interchangeable designation is expected to play a crucial role in the widespread adoption of biosimilars. Once a biosimilar receives this designation, pharmacists will be able to substitute it for the brand-name drug without needing to consult the prescribing physician, much like generic drugs.
This designation is expected to be awarded to several Humira biosimilars by 2025. Until then, Optum Rx and other PBMs will continue to offer Humira as an option, albeit not the preferred one. Once the interchangeable designation is granted, it is likely that the adoption of biosimilars will increase even further, potentially transforming the market for biologic drugs in the U.S.
The Future of Humira and Biosimilars in the U.S. Market
As Humira biosimilars continue to gain traction, it is expected that the market for biologics will undergo significant changes. With the inclusion of biosimilars like Amjevita and Hyrimoz on the formularies of major PBMs, patients will have access to more affordable treatment options without compromising on quality.
The increasing use of biosimilars could also pressure pharmaceutical companies to reduce the prices of branded biologics like Humira. In the long run, this trend could lead to a more competitive market that benefits both patients and the broader healthcare system.
Frequently Asked Questions (FAQs)
Q1: Why is Optum Rx removing Humira from its preferred formularies?
A. Optum Rx is removing Humira to prioritize cheaper biosimilar options, such as Amjevita, starting in January 2025. This move aims to reduce drug costs for patients and the healthcare system.
Q2: What are biosimilars, and how are they different from Humira?
A. Biosimilars are nearly identical copies of biologic drugs like Humira. They offer the same therapeutic benefits at a lower cost, making them a more affordable alternative.
Q3: Will patients still have access to Humira through Optum Rx
A. Yes, patients can still access Humira through Optum Rx until biosimilars receive the FDA’s interchangeable designation, expected in 2025.
Q4: What other PBMs have taken similar actions?
A. CVS Caremark and Cigna’s Express Scripts have both removed Humira from their formularies in favor of biosimilars like Hyrimoz.
Conclusion
The decision by Optum Rx to remove Humira from its preferred formularies represents a significant shift towards promoting biosimilars as cost-effective alternatives to high-priced biologic drugs. With the introduction of Amgen’s Amjevita and other biosimilars, PBMs like Optum Rx aim to lower prescription drug costs for millions of Americans while ensuring that patients receive the same level of care. As the FDA moves closer to granting interchangeable designations to these biosimilars, the market for biologic drugs in the U.S. is poised for a transformative change.
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