Cigna's pharmacy benefits unit, Express Scripts, plans to stop covering AbbVie's blockbuster rheumatoid arthritis drug, Humira, on some of its preferred formularies starting in 2025. The company will instead recommend more cost-effective biosimilars, following a similar move by CVS Health's Caremark earlier this year.
Key Findings:
Cigna's Decision: Express Scripts plan to remove Humira from certain preferred drug reimbursement lists by 2025.
Biosimilar Alternatives: The company will promote biosimilars like Cyltezo, Simlandi, and an unbranded version of Hyrimoz as alternatives.
Market Impact: This decision aligns with a broader industry shift towards biosimilars, which could reduce Humira's market share.
How It Works: Biosimilars are drugs that are highly similar to already approved biologic medicines (like Humira), with no significant differences in terms of safety, purity, or effectiveness. By opting for biosimilars, Cigna aims to reduce healthcare costs without compromising on treatment efficacy.
Why This Matters: It has significant implications for multiple stakeholders across the healthcare ecosystem. Patients may benefit from lower costs and increased access to treatments, but may need education on biosimilar efficacy and safety. Healthcare providers must adapt their prescribing habits and stay informed about insurance coverage for biosimilars. The pharmaceutical industry faces increased competition, potentially driving innovation and price reductions. Insurance companies and the broader healthcare system could see substantial cost savings.
As biosimilars become more prevalent, this trend could reshape treatment approaches for chronic conditions like rheumatoid arthritis, striking a balance between cost-effectiveness and clinical efficacy.
In Practice: Healthcare providers must stay informed about the specific biosimilars covered by insurance plans. Pharmacists should be prepared to educate patients on the efficacy and safety of these alternatives, ensuring a smooth transition for those switching from Humira.
Beyond the Headline: The move by Cigna mirrors similar actions by other pharmacy benefit managers (PBMs) like CVS Health, indicating a broader industry trend. This transition could accelerate the adoption of biosimilars, which have been slower to gain market share despite their cost advantages.
Big Picture: Cigna's decision may signal a significant landscape shift, where cost pressures and increased competition from biosimilars could challenge the dominance of established biologics. This could lead to broader changes in drug pricing and insurance coverage strategies.
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