Savings From Interchangeable Biosimilars May Be Muted

by Leslie Small

The month of October brought two important developments for interchangeable biosimilars. On Oct. 15, the FDA approved Cyltezo (adalimumab-adbm), the first interchangeable biosimilar version of blockbuster autoimmune condition treatment Humira. And on Oct. 20, Cigna Corp.-owned Express Scripts revealed that it will now prefer Semglee (insulin glargine-yfgn) — the first FDA-approved interchangeable biosimilar on the U.S. market — over the branded long-acting insulin Lantus on the PBM’s largest formulary.

Semglee gets PBM nod:

• Semglee initially was not approved as a biosimilar, and the original drug had a wholesale acquisition cost (WAC) of $147. The new interchangeable version has a distinct National Drug Code and a much higher WAC of $404. Mesfin Tegenu, CEO and chairman of RxParadigm, tells AIS Health that the drug’s increased price may have helped it get on Express Scripts’ formulary, since PBMs often favor drugs with high list prices that can command higher rebates.
• “The potential loser in this case might be the patient, who potentially can get stuck with a higher copay or deductible. This is how the rebate to net bubble keeps on inflating drug cost,” he says. “Unfortunately, even biosimilars are not spared.”
• Still, Express Scripts’ move may have ripple effects, suggests Elan Rubinstein, Pharm.D., principal at EB Rubinstein Associates. “Because [Express Scripts] is one of the largest PBMs in the country, these changes may influence the prescribing preferences of physicians, to be less favorable to Lantus and Basalgar [an insulin that’s biologically similar to Lantus], and to be more favorable to Semglee,” he says.

Cyltezo’s impact may be limited:

• The potential implications of Cyltezo’s approval as an interchangeable biosimilar won’t be felt until at least mid-2023, when the drug is set to launch in the U.S.
• Even when Cyltezo does launch, Renee Rayburg, R.Ph., vice president of specialty clinical consulting at Pharmaceutical Strategies Group, points out that it is based on Humira’s original formulation, before AbbVie reformulated it to be “citrate free,” creating 50% less volume of the injectable drug and allowing for a thinner needle.
• Rayburg says she examined drug utilization among a handful of her firm’s employer clients and noticed that a large majority of patients taking Humira are now on the citrate-free version. Therefore, patients and prescribers may be reticent to voluntarily switch to Cyltezo — and resistant if formulary changes essentially make that decision for them.

From RADAR on Drug Benefits