CVS Health announced on January 3 that it will exclude AbbVie’s Humira from its standard national formularies, effective April 1, 2024.
As a result, CVS Caremark has become the first major pharmacy benefit manager (PBM) to exclude of Humira in favor of biosimilars with “a significantly lower list price than the reference product,” according to the press release.
“For members transitioning to a biosimilar, CVS Caremark will help ensure a seamless experience, including proactive member and prescriber notification of this change 60 days in advance, in addition to follow-up text message reminders and online education. CVS Caremark will meaningfully engage prescribers to guide them through appropriate next steps to help transition plan members. Because current Humira authorizations will be transitioned to the preferred biosimilar products, members and prescribers will not need to obtain a new prior authorization review with this product transition,” the company stated.
From the biosimilar industry’s standpoint, it is crucial for PBMs and plans alike begin to exclude Humira or prefer biosimilar agents over Humira. Based on the 2023 estimates, biosimilars made almost no inroads into AbbVie’s marketshare dominance, despite offering competitive pricing and comparable formulations.
It is unknown how CVS Health’s announcement aligns with the corporate strategy announced last August: that it would produce its own biosimilar adalimumab with Sandoz plays. According to CVS, the new venture Cordavis would be launched sometime in 2024, and it will produce an unbranded biosimilar based on Sandoz’s Hyrimoz® at a low list price. The company’s most recent announcement did not name which adalimumab biosimilar(s) would be covered in Humira’s absence.
