- Express Scripts will include Cyltezo and both Sandoz products (Hyrimoz and unbranded adalimumab-adaz) – inflammatory disease biosimilars with competitive net costs – as preferred products on the National Preferred Formulary alongside HUMIRA
- Both the Cyltezo and Sandoz additions offer clinically effective and cost-effective options for patients and physicians
- Biosimilars have potential to save the U.S. health care system up to $375 billion in total pharmacy spend over the next decade
ST. LOUIS, July 10, 2023 -- Express Scripts, the pharmacy benefits management (PBM) business of The Cigna Group's (NYSE: CI) Evernorth, announced today that as part of its commitment to driving greater affordability for clients and people living with inflammatory conditions, it will add three additional biosimilars to its National Preferred Formulary (NPF). The addition of these products that offer competitive net costs to HUMIRA, the top selling pharmaceutical drug in the world, will also support greater patient access and choice.
"In any industry, competition often leads to lower prices, and until recently, HUMIRA had little competition. Since it was introduced, its list price increased by 470%, and by adding multiple clinically-equivalent, cost-effective biosimilars to our formulary, we can now use the opportunity created by competition to drive greater savings for our clients and the nearly 100 million Americans we serve," said Adam Kautzner, Pharm.D., President of Express Scripts. "Embracing biosimilars as they come to market builds on our efforts over the past decade to support greater adoption, just as we did when generics first became available over 30 years ago. We believe that, like generic medications, biosimilars can drive greater affordability for individuals with chronic and complex conditions who need it most."
Express Scripts will prefer the following biosimilar products on its NPF, offering competitive alternatives to HUMIRA (adalimumab):
- Cyltezo (adalimumab-adbm) (Boehringer Ingelheim), the first interchangeable biosimilar with HUMIRA, low concentration formulation
- Adalimumab-adaz (Sandoz), high-concentration formulation, unbranded
- Hyrimoz (Sandoz), high-concentration formulation
Biosimilars for inflammatory conditions have the potential to reshape the specialty medicine landscape. According to Express Scripts trend data, inflammatory medications represented nearly 25% of total drug spend across its commercial book of business in 2022. Evernorth analysis further estimates that competition created with biosimilars can save the U.S. $225 billion to $375 billion in total pharmacy spend over the next decade.
"Our formulary decision process is guided by clinical effectiveness first and foremost, while also considering the needs and continuity of care for patients, in addition to competitive cost savings to our clients. Our decision to add the Sandoz products, as well as the interchangeable product Cyltezo, to our NPF supports greater affordability across this entire treatment class. We gladly welcome new biosimilar options and pricing strategies that enable us to effectively lower net costs and deliver long-term value, whether it's by lower list prices or deeper discounts for our clients and patients," said Harold Carter, Chief Pharma Trade Relations Officer, Express Scripts.
Express Scripts has long advocated for greater adoption of biosimilars because the competition they bring to the market enables pharmacy benefits strategies that will drive greater access and savings for plan sponsors and members. Preferred formulary placement is one tool to encourage the use of more clinically sound and cost-effective products (including certain biosimilars). For example, Express Scripts added Semglee, the first FDA-approved interchangeable biosimilar basal insulin, to its NPF beginning in 2022. In doing so, the company estimates more than $20 million savings for plan sponsors in one year.
The biosimilar Amjevita (Amgen), citrate-free, low concentration formulation, is currently preferred on the Express Scripts NPF and the National Preferred Flex Formulary for 2023. Express Scripts will continue to conduct individual reviews of new biosimilar products as they become available to ensure each product meets the clinical standards required for formulary placement – in addition to cost-savings. The company is also committed to supporting the market transition to biosimilars, while preserving choice and flexibility for patients.
About Evernorth Health Services
Evernorth Health Services creates pharmacy, care and benefits solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Evernorth capabilities are powered by our businesses, including Express Scripts, Express Scripts® Pharmacy, Accredo, eviCore and MDLIVE, along with holistic Evernorth platforms and solutions that move people and organizations forward. All Evernorth solutions are serviced and provided by or through operating affiliates of Evernorth Health, a wholly owned subsidiary of The Cigna Group (NYSE: CI), or third-party partners. Learn more at evernorth.com.