In late April, Evernorth announced that its health plan Cigna and pharmacy benefit manager (PBM) Express Scripts would add coverage June 1 for the adalimumab biosimilars Cyltezo® by Boehringer Ingelheim and Simlandi® by Alvotech/Teva. On August 23, Evernorth took things a step further, announcing that it will exclude Humira® from its largest commercial formularies for the 2025 benefit year.
In addition to the two biosimilars covered in 2024, Express Scripts will add Sandoz’s unbranded version of Hyrimoz® to its 2025 formulary. Express Scripts had also previously announced that Quallent Pharmaceuticals–branded biosimilars are also covered. These are manufactured in conjunction with undisclosed biosimilar makers (we’re guessing Sandoz, at least, based on its original CVS Health–Cordavis deal). The private-branded biosimilar is available without patient cost sharing through Evernorth’s Quallent subsidiary.
Adam Kautzner, President of Evernorth Care Management and Express Scripts, said, “With this latest update, we’re prepared to embrace the savings biosimilars offer and pave the way for access to the next wave of prescription drug blockbusters coming down the pike.”
Although the effect of the initial formulary change by Evernorth is not yet known, unless coverage for Humira is dropped, we believe that growth in biosimilar utilization will be stunted. The new move by Evernorth makes Express Scripts the second of the big 3 PBMs to offer a formulary that excludes Humira from coverage. When CVS Health announced their move, it immediately and significantly dented Humira®’s marketshare nationally.
The effect of Express Scripts having a zero copay or coinsurance on the Quallent-branded biosimilars may be limited, as virtually all commercial plan members prescribed adalimumab are eligible for copay coupons, limiting their out-of-pocket expense. The major lesson of the 2023–2024 experience is that formulary exclusion of the reference product is needed to rapidly increase biosimilar utilization.
