This week, OptumRx announced that AbbVie’s Humira® will not be the sole covered adalimumab product in 2023 and it will not be advantaged over biosimilars. The announcement made at an HLTH conference on November 15 was the first official pronouncement by a major pharmacy benefit manager (PBM) regarding adalimumab coverage plans.
Heather Cianfrocco, CEO of OptumRx, stated that it will cover up to 3 biosimilars at parity with Humira, and Amjevita®, the first biosimilar adalimumab to be launched (in January 2023) will be the first biosimilar covered by OptumRx.
Speculation as to when payers and their PBMs will begin to move away from Humira contracts is rampant. One side of the argument is that payers expect AbbVie to aggressively increase rebates to maintain market share; PBMs, plans, and insurers may do well to retain Humira’s current positioning and grab those significant savings, particularly early in 2023. On the other side of the argument, payers need to embrace biosimilars alongside Humira to position themselves for a 2024 with dynamic changes in pricing among the eight or nine competitors. Amjevita coverage is seen as the first test for payer’s 2023 decisions.
OptumRx clearly has chosen the latter strategy for its 66 million people whose pharmacy benefits are managed by them. Ms. Cianfrocco said that bringing adalimumab biosimilars onto its drug formulary will improve patient choice for high-quality biologic treatments. For its part, AbbVie has not announced an aggressive move to exclude biosimilars from coverage.
OptumRx’s announcement could have implications for other aspects of the autoimmune marketplace. For example, it is not yet known whether AbbVie, which has emphasized bundled or portfolio contracts that include their Skyrizi® and Rinvoq® interleukin agents, veer away from this strategy. Payers have tended to include these autoimmune drugs on formulary only because they resulted in the maximum savings (i.e., rebates) for Humira, which accounts for the lion’s share of anti-TNF spending.
The other major PBMs, including Express Scripts and CVS Health, are expected to reveal their Amjevita coverage strategies, as well as their 2023 approach to adalimumab biosimilars, in the coming weeks.
