Real-World Utilization of Targeted Immunomodulators for Chronic Conditions in a Commercially Insured Population

This research by Navitus examines real-world claims data on targeted immunomodulator utilization in a commercially insured population, with a focus on what the findings suggest for biosimilar adoption, plan cost management and continuity of care. The analysis found that after the reference adalimumab product was removed from formulary, adalimumab biosimilar first fills reached 100% by the fourth quarter of 2024, contributing to a 73% reduction in plan-paid PMPM (per member per month) for adalimumab while member-paid PMPM for targeted immunomodulators remained low. This research pairs those cost findings with persistence and switching data, including 63% persistence after first fill and 13% of patients switching therapy, to argue that biosimilar strategies should be evaluated not only on savings, but also on implementation, patient affordability and treatment continuity.