More than ten biosimilars to Humira® were launched in 2023, introducing price competitiveness for one of the most utilized drugs on the market. Taking advantage of this opportunity, Navitus was an early adopter in adding low wholesale acquisition cost (WAC) / low rebate biosimilars to our formulary.
Navitus remains committed to making medications more affordable and continues to support the availability of biosimilars to reduce cost within the pharmacy benefit. However, formulary additions, without more directive action, will not fully capture the savings available through lowest-net-cost formulary management.
To that end Navitus has been actively monitoring market dynamics and has decided to remove Humira effective June 1, 2024 from our commercial and exchange formularies. This action is intended to drive the overall lowest net cost for clients through utilization shifts to the low WAC / low rebate biosimilars Adalimumab-adaz, Adalimumab-fkjp, and Hadlima™.
What is a biosimilar?
The FDA defines a biosimilar as a biological product that is highly similar to an FDA-approved biologic (known as the reference product) and used in the prevention or treatment of disease. While not chemically identical, a biosimilar has no clinically meaningful difference from a reference product. It is FDA-approved for use after rigorous evaluation and testing is demonstrated by the manufacturer applicant.
Biosimilars are not generics
Generic drugs are chemically identical to their reference product. Because biosimilars are made from living organisms, they don’t contain identical ingredients. Therefore, stringent testing and demonstration is required for approval.
Decision philosophy
Since January 1, 2023, the cost of Humira has been reduced by approximately 50%. As biosimilars entered the market, the addition of more options including several with low WAC drove cost declines in the category.
On October 1, 2023, Navitus added the following low WAC / low rebate biosimilar options: Adalimumab-adaz, Adalimumab-fkjp, and Hadlima™. Because Navitus operates as a full pass-through pharmacy benefit manager, there is no incentive to create spread by preferring a high cost / high rebate product when net costs are the same. Our focus is on what offers the most benefit to clients and members. When selecting these products, Navitus considered the following:
• The low WAC product supports lower upfront drug costs for plan sponsors. This is compared to spending more now and awaiting a rebate several months later.
• The low WAC product reduces out-of-pocket expenses for members enrolled in high-deductible health plans and offers stability for members on-therapy.
By removing Humira from the formulary effective June 1, 2024, Navitus clients can expect to see cost savings, as utilization shifts to these low WAC options and guides to a lower net cost compared to Humira.
As the biosimilar landscape continues to evolve, Navitus will monitor and keep stakeholders apprised of new products and drug pipeline activity.
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WRITTEN BY BRENT EBERLE As Senior Vice President, Chief Pharmacy Officer, Brent oversees Navitus’ health strategies division, which is responsible for clinical and population health initiatives, drug utilization review programs, formulary and rebate management, and specialty pharmacy operations.
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