Express Scripts To Begin Adding Inflammatory Conditions Biosimilars to Largest Formularies Next Year


Good news is on the horizon for Americans taking Humira, one of the most widely used specialty medications, which treats inflammatory and skin conditions. In 2023, a number of biosimilar therapies clinically equivalent to Humira are expected to become available. These FDA-approved medications offer no clinically meaningful differences in safety and efficacy, and will help drive down health care costs.

To advance affordability while protecting patient access and choice, Express Scripts will add biosimilars to its largest formularies as preferred products to treat inflammatory conditions.

“This decision helps us achieve lower costs for patients and plans while giving patients and providers choice and flexibility as additional biosimilars come to market,” said Harold Carter, Chief Pharma Trade Relations Officer for Express Scripts. “Lack of competition allows sky-high prescription drug prices. We can generate more competition in the inflammatory drug class by adding biosimilars to our largest formularies in the coming months and do what we do best – lower the costs of medications for the millions of people we serve.”  

Until now, biologic specialty inflammatory medications like Humira have faced little or no competition. With such a strong market edge, manufacturers were able to set high launch prices and hike prices annually. According to Express Scripts trend data, specialty medications drive half of total drug spending, despite being used by less than 2 percent of the population.

Express Scripts has long advocated for the approval and adoption of biosimilars and encouraged greater competition to drive down costs. Preferred formulary placement is a tool to help plans encourage the use of more cost effective products (including certain biosimilars) instead of higher cost alternatives. For example, Express Scripts added Semglee, the first FDA-approved interchangeable biosimilar basal insulin, to the National Preferred Formulary (NPF) beginning in 2022. In doing so, the company estimates more than $20 million savings for plan sponsors in one year.

These FDA-approved biosimilars have the potential to reshape the specialty medicine landscape, Carter said.

By 2024, Express Scripts expects biosimilars for inflammatory conditions to create market competition with the biologics that represent nearly half of current spending on conditions like rheumatoid arthritis. The arrival of these products represents a huge opportunity to drive savings in a dynamic landscape. 

How Express Scripts Is Working To Ensure Access and Support Future Use of Biosimilars

In the coming months, Express Scripts will continue to evaluate all biosimilar products to Humira for placement on its largest formularies and will provide updates related to specific changes as available. Greater competition in the inflammatory drug class following the addition of biosimilars will create significant savings for clients.  

“By adding biosimilars at the preferred status in the coming months, we can provide options in this complex and dynamic market. As always, we will remain nimble and continue negotiating with drug manufacturers to help patients and plans achieve lower costs for their medications,” Carter said. “It takes market competition to drive down drug prices long-term, and it requires close care coordination to support patients starting a new medicine. We are uniquely positioned to do both – and in the process, support access to these safe, effective medicines for those we serve.”