Leveraging biosimilars to drive savings and support patient access

By the end of 2023, 11 biosimilars for Humira will be available for patients living with inflammatory conditions, enabling lower costs for a drug class that currently represents nearly 25% of total drug spend across Express Scripts’ commercial book of business.

This year marks a turning point in the long road to entry for biosimilars in the United States. By the end of 2023, 11 biosimilars for Humira (adalimumab) — the top-selling pharmaceutical in the world — will be available for patients living with inflammatory conditions in the U.S. Even more biosimilars for products that treat inflammatory conditions are expected in 2024 and beyond, enabling lower costs for a drug class that represented nearly 25% of total drug spend across Express Scripts’ commercial book of business in 2022. 

In any industry, competition often leads to lower prices, and until recently, Humira had little competition. Since Humira was introduced to the market, its list price has increased 470%. Without competitor products, manufacturers can — and do — increase prices to whatever the market will bear, which can ultimately leave health plans, employers, and patients to bear the brunt of rising drug costs. Express Scripts has long advocated for greater adoption of biosimilars because the competition they bring to the market creates opportunities for us drive greater savings for our clients and the nearly 100 million Americans we serve.

Biosimilar availability in the U.S. has been slow, largely due to ongoing patent litigation with manufacturers. We estimate that the competition created with biosimilars can deliver $225 billion to $375 billion for plan sponsors in drug cost savings by 2031. Just as we did when generics became available over 30 years ago, Express Scripts will continue to support greater access and long-term savings for our clients and members for the prescription medications they need.

Over the years, Express Scripts has seen how competition works quickly and effectively to lower drug prices and keep price increases in check. For example, the list price of Lantus, a long-acting insulin injector, more than doubled during the five years after it was approved in 2010, until competing products entered the market in 2015. Following the entry of several biosimilar options — including an interchangeable option — the price for Lantus decreased. Express Scripts was able to further drive down the net cost for Lantus and pass along savings to our clients. In turn, plan sponsors were able to apply those savings to lower premiums, expand medication lists, fund wellness programs, or pass savings directly to patients at the pharmacy counter.

Biosimilars for inflammatory conditions have the potential to reshape the specialty medicine landscape. By 2024, these medicines have the potential to drive additional market competition with existing biologics and specialty medications that represent half of the current spending on inflammatory conditions like rheumatoid arthritis.

Preferred formulary placement is one step that can encourage the use of clinically sound, cost-effective products. For example, Express Scripts added Semglee, the first FDA-approved interchangeable biosimilar basal insulin, to the National Preferred Formulary (NPF) beginning in 2022. We estimate the resulting savings with this addition can exceed $20 million for plan sponsors.

In the inflammatory drug class, Express Scripts added the Humira biosimilar Amjevita to the NPF beginning in 2023, and we expect the availability of additional biosimilar products in this drug class will enable us to secure deeper savings for plan sponsors and patients.

The outlook for biosimilars is promising. As new biosimilars come to market, we will conduct individual clinical reviews for each product to ensure our decisions for our standard formularies are guided by clinical effectiveness first and foremost, while also considering the needs and continuity of care for patients, in addition to cost savings. Express Scripts is also committed to helping the market transition to biosimilars while preserving choice and flexibility for patients. It takes competition to drive down drug prices long term and requires close care coordination to support patients starting a new medicine. Express Scripts is uniquely positioned to do both. 

To learn more about how PBMs lower drug costs, read here.

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Express Scripts National Preferred Formulary
The National Preferred Formulary is the industry’s most powerful tool for payers to achieve optimum trend management while preserving plan members’ access to clinically effective generic and brand name drugs. Our drug formulary management strategy is rooted in five key principles: clinical appropriateness, flexibility, value, customization and choice.