UnitedHealth Group’s pharmacy benefit manager Optum Rx Tuesday said it will put three less expensive “biosimilar” versions of Abbvie’s pricey rheumatoid arthritis drug Humira “in the same position as the brand” on the PBM’s preferred list of drugs known as a formulary.
Humira, approved by the U.S. Food and Drug Administration 20 years ago, has for years now been one of the nation’s most costly drugs generating more than $20 billion in sales for its maker, Abbvie in 2021 alone. Humira was recently described by BioPharma Dive as “the most lucrative pharmaceutical monopoly in industry history.”
Thus, Optum Rx’s move next year is certain to create competition from less expensive biosimilars and is expected to be quickly followed by other health insurers and PBMs given the potential cost savings to the U.S. healthcare system. UnitedHealth has tremendous clout in the healthcare industry as the nation’s largest healthcare company and parent to both the health insurer UnitedHealthcare and Optum Rx, one of the nation’s largest PBMs.
Because Humira is so expensive at more than $50,000 a year per patient, Optum Rx’s decision means potentially thousands of patients could be shifted in 2023 to cheaper alternatives and save Optum Rx clients and the U.S. healthcare system potentially billions of dollars a year.
Optum Rx will continue to have Humira on its formulary in 2023 but also “add up to three biosimilars on formulary – in the same position as the brand – starting with the first available biosimilar in 2023,” UnitedHealth and Optum Rx disclosed Tuesday during the HLTH 2022 conference in Las Vegas.
There have already been an increasing number of studies that show biosimilar versions of Humira are just as effective and safe as Humira. Thus, doctors and executives at PBMs see no reason why patients cannot choose the less expensive biosimilar versions.
“The availability of Humira biosimilars is one of the biggest opportunities in years to lower costs and increase accessibility for consumers who need expensive specialty drugs,” OptumRx said in a statement Tuesday. “Our biosimilars decision maintains high quality of care while providing flexibility and choice for patients and providers, with no disruption to treatment.”
More broadly, biosimilar versions of drugs are expected to save health plans, the government and consumers large amounts of money as more are introduced in coming years.
“The coming wave of biosimilars is a pivotal opportunity to reduce cost and increase access to care for millions of people,” Optum Rx chief executive officer Heather Cianfrocco said. “OptumRx fully supports advancement of the biosimilar market as part of our commitment to providing patients and providers with high quality and affordable care, flexibility, and choice.”
Humira, which treats autoimmune conditions including Crohn’s disease and rheumatoid arthritis, has generated nearly $200 billion in sales for its makers over the last two decades.
Neither Abbvie nor its former parent company, Abbott Laboratories, discovered Humira. Abbott under then CEO Miles White came across Humira by acquisition, a 2001 purchase of Knoll Pharmaceuticals for nearly $7 billion in cash. Abbott spun off its branded drug business in 2013 into what has become Abbvie.
When Abbott bought Humira, the biologic was already in the final stages of development and late stage clinical trials made the product look promising. Knoll also brought Abbott several top-selling drugs including the popular thyroid treatment Synthroid and other brand name prescriptions that generated billions of dollars in sales over the years making the acquisition of Humira less of a financial risk.