Seven new alternatives to the high-cost Humira drug will be available in July. Some will be offered at significantly lower prices, but will patients see big savings?
Lowering drug prices for patients is not always as simple as introducing low-cost options to a marketplace.
A complex system of confidential rebates that drug manufacturers offer to pharmacy benefit managers, companies that mediate sales between drugmakers and insurers, can incentivize PBMs to choose certain drugs to offer on their plans.
“PBMs and health plans both like to do business with the branded drug companies,” said Marianne Fazen, executive director of the DFW Business Group on Health, a coalition of about 55 mid to large DFW firms. “And the reason they like it so much is because they get huge rebates and a huge spread in the cost of what the health plans and PBMs are able to share with the employers.”
Humira is a biologic drug, meaning it goes through a more complex manufacturing process than most drugs. Due to this complexity, competing companies can’t make exact replicas. Instead, they make highly similar versions, called biosimilars.
These biosimilars are still expensive, but cheaper than Humira. Exact prices and drugmaker rebate incentives for biosimilars and insurers are not yet clear.
Some big PBMs have already indicated their intent to offer select biosimilars.
OptumRx will offer the already-released Amjevita, the first interchangeable biosimilar Cyltezo and soon-to-come Hyrimoz and is considering adding more, the company said.
CVS Caremark also offers Amjevita and plans to add one or more biosimilars as more become available, basing their decisions on efficacy, supply and cost, the company said in a statement.
Pricing for most biosimilars is not yet clear, meaning it remains to be seen whether patients see significant savings.
“I unfortunately think that payers and PBMs are still going to complicate the marketplace,” said Hannah Fish, strategic communications director at the National Community Pharmacists Association. “You can already see with the one biosimilar that was released earlier in January and a couple indications for those that are coming out sooner this upcoming month … the games, if you will, that are already being played as far as what the discounts are going to be projected at.”
