The launch of biosimilars to the reference drug Humira, a drug that has been top in spend and continued for many years across different insurer types, has amplified the complex market dynamics of drug pricing in a competitive market. Starting in February of 2023, over 11 biosimilars from 8 manufacturers for the brand drug Humira have launched at varying discounts to the list price of Humira from a 5% to an 81% discount.1 While Humira is the 10th drug in the US to have biosimilars launch, this launch has proven to be the most complex to date of any biosimilar launch.2 Payers have had to consider many factors clinically and financially when choosing their strategy with these biosimilar launches.
Manufacturers of Humira biosimilars have launched at a variety of prices, with several manufacturers choosing to launch both a high wholesale acquisition cost (WAC) product and a low WAC product in hopes of attracting interests of varying plan types. Payers are taking in a variety of factors to decide their path in this landscape from patient affordability to potential rebate guarantees in contracts. A high WAC product may be attractive in markets with large employer groups who look for the highest rebates and use those dollars to lower their members premiums or offer other healthy incentive type programs. A plan that offers a formulary geared toward low net costs combined with high deductible benefits may be more inclined to steer towards lower list price products to ensure savings are passed directly to members at the point of sale.
Payers are carefully navigating this launch and choice of preferred products given that they likely have multiple plan types with different interests. We have seen that most payers are choosing to keep Humira as a preferred product while adding 2 biosimilars as preferred alongside it. Keeping Humira on the formulary is attractive to payers as it allows for continuation without member and provider disruption and likely leads to immediate savings from enhanced rebates without having to shift market share as Humira faces price pressure from the biosimilars. Manufacturers of biosimilars are looking to gain market share in a highly competitive environment where they are competing to be placed in a parity position to Humira. Offering multiple pricing strategies can put them at a better competitive advantage for those payers who may be inclined to offer multiple strategies across different segments. As payers decide whether to add biosimilars as preferred products in addition to or in total replacement of Humira, they will need to consider various scenarios.
Adding biosimilars in addition to Humira as preferred:
- What market share shift do they expect to see away from biosimilars?
- How will total rebates be affected?
- How will total spend be affected?
Removing Humira from preferred and adding one or more biosimilars as preferred:
- How quickly can they move market share away from Humira in the scenario they no longer prefer Humira?
- What is the cutoff to breakeven or, in other words, how much market share do they need to convert away from Humira to the biosimilar to overcome the loss of rebates on Humira?
- How will total rebates be affected?
Payers may not actively drive away from Humira to the parity preferred biosimilars if there are contractual restrictions, but they may do things to encourage or ease the transition, particularly in scenarios where those biosimilars may be at a lower net price compared to Humira. Those strategies may include proactively loading prior authorizations for the preferred biosimilars for members that have an active prior authorization for Humira and notifying members they may switch to one of those alternatives if they prefer. It can also include active communication about the new preferred product strategy to the health plan or pharmacy benefit managers’ preferred specialty pharmacies, top providers for the medication and their members. As payers model out the various scenarios, these tactics may be considered.
This market event will set the stage for future events as biosimilar manufacturers watch who comes out on top based on their pricing strategy. Securing a place as a preferred product on formulary will only be the first step with payers who have multiple options. Biosimilar manufacturers should anticipate these type of market dynamics and determine a competitive pricing strategy that will be appealing to a variety of payer types. It will also be key to provide both provider and patient education to prevent any downstream barriers to adoption once preferred market access is secured. Examples may include ensuring providers understand what is required for a non-interchangeable product (ie, brand name on prescription) and for patients what is a biosimilar and support for any new administration devices. Lastly, engaging with payers on what strategies can be executed to drive biosimilar adoption—even in a parity position—and how they can support those strategies could increase the success of biosimilar adoption.
- Fein, AJ. Four crucial questions about the Humira biosimilar price war. Drug Channels. July 18, 2023. https://www.drugchannels.net/2023/07/four-crucial-questions-about-humira.html
- US Food and Drug Administration. Biosimilar product information. US Food and Drug Administration. August 24, 2023. https://www.fda.gov/drugs/biosimilars/biosimilar-product-information_