“Opportunity does not waste time with those who are unprepared.” – Idowu Koyenikan

With over $16 billion in sales in 2020, the biologic drug Humira (adalimumab) remains far and away the top-selling drug by dollars in the United States. Humira is used in the treatment of conditions such as plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, inflammatory bowel disease, and ankylosing spondylitis. 

Humira’s manufacturer, AbbVie, has long kept competitors at bay through a “patent thicket” of over 100 patents that have thwarted competitor drugs, biosimilars, from coming to market. Following extensive litigation and negotiation, at least six Humira biosimilars will finally enter the market in 2023. These biosimilars are expected to be less expensive than Humira and drive down the unit cost of Humira through competitive market effects. 

Due to only a handful of relatively new biosimilar drugs being available in the United States, many people are unaware of biosimilars or don’t fully understand how they differ from generic drugs. While both generic drugs and biosimilars are less costly alternatives to brand-name drugs, there are important differences between the two.

The ability to substitute one drug for another is determined at the state level. While pharmacists can generally substitute generic drugs for brand-name drugs, most states do not allow substitution of biosimilar drugs for a biologic reference product without physician consent. However, substitution may be possible for the few biosimilars that have been designated as interchangeable by the FDA. Interchangeable products meet a higher standard to ensure that switching between the reference product and biosimilar does not pose additional risk to a patient. Cyltezo, one of the biosimilars for Humira that will be marketed in 2023, recently received an interchangeable designation.

Strategies to Maximize Cost Savings Opportunities

Unfortunately, an “if we build it, they will come” attitude may not be applicable to Humira biosimilars. Despite being less expensive than their reference product counterparts, some existing biosimilar drugs in the United States have had relatively slow uptake due to both patient and provider hesitancy and plan designs that don’t incentivize use of biosimilars. 

This begs the question – “What actions can be taken now to maximize cost savings opportunities for Humira biosimilars when they become available?” Below are actions you can take now to develop and implement strategies that will lead to higher adoption rates of Humira biosimilars: 

  1. Understand uptake of current biosimilar drugs among your members by reviewing utilization of the eight biologic reference products with biosimilar drugs currently available in the US. Biosimilar drugs for Remicade (infliximab), Avastin (bevacizumab), Rituxan (rituximab), Neuopogen (filgrastim), Neulasta (pegfilgrastim), Herceptin (trastuzumab) Epogen/Procrit (epoetin alfa), and Lantus (insulin glargine) are FDA-approved and marketed in the United States. Reviewing adoption rates of biosimilars to Remicade may be particularly informative because Remicade and Humira are used to treat similar conditions and belong to the same drug class. Additionally, while many of the biosimilar drugs and their reference products are mainly covered through medical benefits, both Humira and Remicade are frequently covered through  pharmacy benefits. 
  1. Review plan design to ensure the use of biosimilar drugs is incentivized. For patients initiating therapy, implement a fail-first approach that requires patients to start  treatment  with a biosimilar drug rather than its reference product counterpart. Ensure that biosimilars are part of your preferred list. 

    Patients should be incentivized to use biosimilars by reducing out-of-pocket costs. Be aware you may be competing with patient rebates from the reference product manufacturer. AbbVie currently advertises reimbursement for eligible patients taking Humira to reduce their out-of-pocket costs to as low as $5 per month. 

    Partner with health plans that provide incentives to providers to use biosimilars either through value-based purchasing or provider reimbursement that favors biosimilars over reference products. 
  1. Educate plan members about biosimilars and offer tools that help them understand related cost savings. Educational materials are necessary to bring awareness to cost-saving opportunities of biosimilars and to combat misinformation that biosimilars may not be as effective or as safe as the reference product. Real-time benefit lookup tools and cost calculators that differentiate costs of reference products and biosimilars can help patients understand potential cost savings for their drugs. 
  1. In addition to targeting members already on biologics, be sure to target outreach to members who have not initiated treatment with a biologic drug, but have conditions that make them likely candidates to initiate biologic therapy. For Humira, these members would include those with plaque psoriasis, psoriatic arthritis, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, polyarticular juvenile idiopathic arthritis, hidradenitis suppurativa, or non-infectious uveitis.

    It is important to target members who have not initiated biologic therapy because there may be greater opportunities for biosimilar utilization in this population than in individuals already taking biologic drugs. Non-medical switching (the practice of switching a patient’s medication for reasons other than the patient’s health or safety) has been controversial among physicians whose patients are already taking a biologic, in part due to a paucity of randomized controlled trials to determine any adverse outcomes.

    Several studies have found that physicians are more willing to prescribe biosimilars in individuals initiating therapy than in those already taking a biologic. 

For a quick over on these cost saving strategies, check out this infographic.

Actionable Cost-Savings Opportunities

Biosimilars to Humira, the top-selling drug in the United States, will finally enter the US market in 2023. To maximize the cost-savings opportunities once these biosimilars become available, you need to review current adoption rates of biosimilars and consider plan design changes, education, and outreach opportunities that should be implemented. 

At Springbuk, we are committed to finding cost-savings opportunities that do not compromise patient quality of care. The use of biosimilars has been an underutilized opportunity. Our new Springbuk Insights™, focused on utilization of biologic reference products and biosimilar drugs, informs users of potential cost-savings opportunities and strategies that can be used to increase biosimilar adoption rates. 

Meet the Author: Janet Young, M.D.
With more than 30 years of experience, Janet Young has provided clinical expertise to the development of healthcare analytics used in provider, payer, employer, and government sectors. Previously, Janet served as a Lead Clinical Scientist at IBM Watson Health, guiding clinical content development related to new models, methods, and analytics using claims, EMR, Health Risk Assessment, and socio-demographic data. 

Janet joined the Data Science and Methods team at Springbuk in Dec. 2019, and has been responsible for clinical oversight of methods and models. Janet received her M.D. from Yale University School of Medicine.