Navitus to Remove Stelara® from Formulary July 1, 2025, Adds Biosimilars to Drive $120 Million in Savings 

As the nation’s first 100% transparent, pass-through PBM, we continue to advance medication affordability by prioritizing upfront, real-time savings over rebated models.

Navitus is committed to reducing pharmacy benefit costs and believes biosimilars play a critical role in doing so. With multiple Stelara® biosimilars entering the market, Navitus will be removing Stelara from commercial and exchange formularies effective July 1, 2025.   

This action furthers our biosimilar strategy, which has delivered significant savings for plan sponsors. By removing Humira® from formulary in June 2024, our forecasted annualized net cost savings for commercial clients is more than $100 million. Clients able to accept the formulary exclusion have saved up to 60% on their net product cost. 

An additional $120 million annualized net savings is expected by removing Stelara from formulary and adding biosimilars.  

Driving Lowest Net Cost: Stelara Biosimilars on Formulary as of April 1, 2025  

Stelara ranks as one of the most expensive prescription drugs on the market, with an estimated wholesale acquisition cost (WAC) of $30,000 per 90mg dose. It is indicated for the treatment of Crohn’s disease, psoriasis, psoriatic arthritis and ulcerative colitis. While Stelara may be dosed every 8 weeks or 12 weeks, many patients require a monthly dose which increases total treatment costs. The introduction and adoption of biosimilars creates competition and opportunities for cost savings. 

Lumicera Health Services, a wholly owned subsidiary of Navitus Health Solutions, has announced a purchase agreement for a lower-priced biosimilar version of Stelara (ustekinumab). Navitus clients that use Lumicera for specialty pharmacy will have access to ustekinumab-aekn and will realize the combined value of a:

• Lowest-net-cost strategy 
• Pass-through PBM
• Acquisition cost-plus specialty pharmacy

Together, Lumicera and Navitus will deliver upfront, real-time net savings of approximately $10,000 per fill compared to the reference product. Plan sponsors will save between $112,000 and $336,000 per patient per year. Lumicera is expected to begin dispensing ustekinumab-aekn July 1, 2025. 

In addition, for clients that do not use Lumicera for specialty pharmacy, the biosimilars Yesintek (ustekinumab-kfce) and Steqeyma (ustekinumab-stba) will be added to Navitus formularies as of April 1, 2025. These biosimilars also provide markedly improved savings over brand Stelara, with both WAC and net WAC estimated to be significantly lower than the reference product.  

Each of these products offers a promising solution to balance effective pharmaceutical treatment with costs. Approved biosimilars for Stelara are shown to deliver comparable therapeutic results for a fraction of the cost. This path furthers our mission to make medications more affordable for the people who need them.    

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 originator, or 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. An approved biosimilar can treat illnesses with the same clinical efficacy as the reference product.

MORE ABOUT Sharon Faust, PharmD, MBA, CSP

Sharon Faust is the Chief Pharmacy Officer at Navitus Health Solutions. She oversees Health Strategies, Provider Services and Lumicera Health Services. She is a licensed pharmacist in Wisconsin and is on the Board of Directors for the National Association of Specialty Pharmacy and the Drug Selection Advisory Committee for CivicaScript®. In 2023, she was awarded the top 50 most influential leaders in Pharmacy award presented by the Pharmacy Podcast network.