Cigna and its pharmacy benefit manager (PBM) Express Scripts has announced that starting June 1, adalimumab biosimilars by Boehringer Ingelheim and Alvotech/Teva will be available to its Evernorth members at a zero copay or co-insurance. The deal comes on the heels of reports of rising biosimilar prescriptions resulting from the CVS Caremark’s preference for another biosimilar and exclusion of reference drug Humira®. The press release may also answer the question regarding the April 19 announcement of a mysterious new strategic partner for Alvotech.
This promises to rapidly increase prescriptions for the two companies’ biosimilars. Accredo estimates that 100,000 individuals currently would be eligible for the switch to a zero-copay biosimilar option from either Humira or another of the covered biosimilars.
Currently, Alvotech’s Simlandi® is interchangeable for the high-concentration formulation of adalimumab, and Cyltezo® is interchangeable for the low-concentration formulation. However, a high-concentration version of Cyltezo is expected to be introduced before the end of the second quarter of this year. The announcement did not specify whether Humira will be excluded from the Express Script’s formulary. According to the press release, “The high- and low-concentration interchangeable biosimilar will be produced for Evernorth’s affiliate private-label pharmaceutical distributor, Quallent Pharmaceuticals, through agreements with multiple manufacturers.” This indicates that a private-label version of Alvotech’s and Boehringer’s biosimilars will be in play, distributed by another entity.
Early on, offering patients lower out-of-pocket costs was considered an essential factor towards encouraging greater biosimilar utilization and switches to biosimilars. A “biosimilar copay tier” was one mechanism through which faster biosimilar adoption could occur, but none of the major plans or PBMs had employed a unique lower-cost copayment tier across their biosimilar coverage. For certain categories, especially the oncology biologics, biosimilar uptake was rapid, without implementing the biosimilar copay tier. A major reason was that the use of copay coupons or other financial assistance consistently reduced patient out-of-pocket costs on these biologics and their biosimilars to very low levels. Therefore, patient costs were not a significant issue, at least until the patient reached the allowable limits of copay accumulators and maximizers. A recent study had confirmed that overall, patients saw little savings through the use of biosimilars. The findings, viewed through this lens, are unsurprising.
The news from Cigna and Express Scripts avoids the issue of patient costs by maintaining the zero copay throughout the year when the patient obtains Cyltezo or Simlandi through its Accredo specialty pharmacy. Technically, this is considered copay assistance by the PBM, but it will not be subject to copay accumulators or maximizers by the PBM.
