Humira Biosimilars Enter the Marketplace – Update on Navitus’ Review

The market entry of biosimilars to Humira® (adalimumab) is long-awaited. These products have the potential to improve affordability in the near- and long-term for patients, plan sponsors, and health plans. Navitus is committed to making medications more affordable for the people who need them and uses established clinical and financial review processes to determine inclusions in standard formularies.

This update provides insight into our decision on the first Humira biosimilar, Amjevita.

The first biosimilar to Humira, Amgen’s Amjevita, launched February 1, 2023. This is the first of many biosimilar products expected to enter the market this year with potential to drive greater affordability of adalimumab therapy for inflammatory conditions.

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.

NAVITUS’ REVIEW

We have anticipated a dynamic adalimumab landscape this year, with biosimilars likely to have positive impact in the marketplace by driving down drug cost. Navitus’ assessment of Amjevita determined that a similar net price was seen between both the high-cost/high-rebate product and the low-cost/low rebate product.

Decision Philosophy

Updated April 4th, 2023

As the market reacted to this first Humira biosimilar, it has been a popular choice of PBMs to include the high-cost/high-rebate product.

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. Currently, that is the low-cost Amjevita product, considering the following:

The low wholesale acquisition cost supports lower upfront drug costs for plan sponsors. This is compared to spending more now and awaiting a rebate several months later.

The low-cost product reduces out-of-pocket expenses for members enrolled in high-deductible health plans and offers stability for members on-therapy. Should a future decision be made to prefer other adalimumab biosimilar(s), the low-cost product helps to maintain affordability until a member’s transition to an alternative preferred product.

Our teams will continue to monitor the evolving landscape as additional biosimilar competition arrives this summer.

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.

Stay Informed and Connected

Receive expert insights, healthcare tips, and important updates on pharmacy benefits, drug recalls, and more—straight to your inbox.

Examining Trends that Drive Informed Decisions

Now Available: 8th Annual Drug Trend Report

See the latest results and access industry insights you need to navigate current trend drivers.

Related blogs

Navigating Healthcare and Improving Outcomes

PBM 101: The Three PBM Business Models

PBM 101: The Three PBM Business Models

In the pharmaceutical and healthcare industry, pharmacy benefit managers (PBMs) are regarded by the media as intermediaries between drug manufacturers, pharmacies, health plans and plan sponsors. But they’re so much more than that. PBMs act as conduits…

An Automated Approach to Diagnosis Verification of GLP-1 RA for Type 2 Diabetes Mellitus (T2DM)

An Automated Approach to Diagnosis Verification of GLP-1 RA for Type 2 Diabetes Mellitus (T2DM)

This study examines the impact of implementing an automated point-of-sale diagnosis verification system for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) compared to traditional utilization management approaches….

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

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….

Achieving Outstanding Results with Tailored Network Strategies

Achieving Outstanding Results with Tailored Network Strategies

A medium-sized city in Michigan with 1,350 members was seeking ways to lower its pharmacy benefit costs, which were growing under its existing traditional pharmacy benefit manager (PBM). With its member covered by a two-tier, open formulary including…

Breaking Through Barriers with Value-Based Plan Design

Breaking Through Barriers with Value-Based Plan Design

Facing increased pharmacy benefit expenses, Blain’s Farm and Fleet, a Midwestern employer group, desired to improve plan performance. Specifically it was interested in educating eligible members about the benefits available to them, promoting cost-effective…

Finding a Solution to Lower Prescription Drug Costs

Finding a Solution to Lower Prescription Drug Costs

The Rural Arizona Group Health Trust (RAGHT) wanted to gain better control of its escalating drug trend with its large, traditional pharmacy benefit manager (PBM). Having only worked with traditional PBMs in the past, RAGHT was interested in exploring…

Empowered by Strategic Opportunities and Service Excellence

Empowered by Strategic Opportunities and Service Excellence

Putnam | Northern Westchester Health Benefits Consortium (PNW HBC) was the first municipal cooperative health plan in the state of New York to become certified by the Department of Insurance. They are dedicated to meeting — and exceeding — the standards…

QALYiQ Program Delivers Significant Savings for Both Members and Health Plans

QALYiQ Program Delivers Significant Savings for Both Members and Health Plans

As part of their treatment plan for hypophosphatasia (HPP), a rare genetic disorder affecting bone and teeth development, one of our members required Strensiq, a medication designed to manage HPP. However, Strensiq’s annual treatment costs ranged from…

RISE: Reporting and Intervention for Stars Excellence

RISE: Reporting and Intervention for Stars Excellence

RISE is a comprehensive Star Ratings Improvement program that focuses on positive outcomes for Medicare Part D (Part D) clinical measures, including: medication adherence for diabetes medications, medication adherence for hypertension, medication adherence…

previous arrow
next arrow