Ustekinumab biosimilars are many and largely sold at big discounts relative to the reference product Stelara. The major PBMs are beginning to publish formularies for 2026. For instance, Express Scripts will have two biosimilars on formulary—Biocon Biologic’s Yesintek and Alvotech/Teva’s Selarsdi (at 90% and 85%, respectively, off the wholesale acquisition cost [WAC] of Stelara) in addition to its unbranded, Quallent version, based on Samsung Bioepis’ Pzychiva product, which we assume will be priced at Quallent’s familiar 46% off of WAC (as in 2025). Stelara will be excluded from formulary, which is a necessary move for the success of the biosimilars.
The ustekinumab biosimilar launches differ from the adalimumab biosimilar launches in a major respect: Only one ustekinumab manufacturer rolled out a dual-pricing strategy for their product this year. Amgen’s Wezlana, which is being marketed and sold through Optum Rx’s private-label distributor Nuvaila, is available at both 5% and 81% WAC discounts. In comparison, at least seven adalimumab biosimilars were offered at high- and low-WAC pricing levels.
Is this a good thing? I’m hopeful that it is. The reason may be clear to most readers. The low-discount versions were offered only to satisfy the PBMs’ and payers’ need for rebates. In 2025, two biosimilars (Samsung/Sandoz’s Pyzchiva and Biocon’s Yesintek) were covered by CVS Caremark, along with the reference product (at full WAC pricing). CVS’s private-label distributor Cordavis offered the two versions of Samsung’s biosimilar at an 86% discount. Quallent’s private-label offerings at a 46% WAC discount are clearly an attempt to straddle the need for lower list prices while still offering some rebates.
Perhaps the PBMs believe that payers are less interested in the former’s desire to gain revenue through spread pricing and are more interested in plotting a future course that does not rely on rebates. If this was the case it would simplify commercialization for biosimilars covered under the pharmacy benefit.
As additional 2026 formulary announcements are made, we’ll watch for any interesting formulary exclusions and/or changes in PBM strategy. For now, it seems that fewer manufacturers are willing to play the dual-pricing game. We may see signs of that not being the case as more 2026 formulary decisions are announced. It would certainly be nice if the initial impression was confirmed. Let’s be hopeful for a change!