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Kaiser humira copay assistance11/10/2023 Kroger canceled its pharmacy contract with Express Scripts last fall, saying it had no bargaining power in the arrangement, and, on Aug. The Federal Trade Commission began a major probe of the companies last year. Yet challenges to PBM practices are mounting. The leading PBMs - Express Scripts, Optum, and CVS Caremark - are powerful players, each part of a giant health conglomerate that includes a leading insurer, specialty pharmacies, doctors’ offices, and other businesses, some of them based overseas for tax advantages. Although rebate numbers are kept secret and vary widely, some reportedly jumped this year by 40% to 60% of the drug’s list price. Industry sources also say the PBMs persuaded AbbVie to increase its Humira rebates - the end-of-the-year payments, based on total use of the drug, which are mostly passed along by the PBMs to the health plan sponsors. In other words, dropping one AbbVie drug would lead to higher costs for others. One of AbbVie’s strategies was to warn health plans that if they recommended biosimilars over Humira they would lose rebates on purchases of Skyrizi and Rinvoq, two drugs with no generic imitators that are each listed at about $120,000 a year, according to PBM officials. “We are competing very effectively with the various biosimilar offerings,” AbbVie CEO Richard Gonzalez said during an earnings call. The drugmaker has told investors it doesn’t expect to lose much market share through 2024. The company’s fight for Humira didn’t stop when the biosimilars finally appeared. Its manufacturer, AbbVie, has aggressively defended the drug, filing more than 240 patents and deploying legal threats and tweaks to the product to keep patent protections and competitors at bay. Humira’s $200 billion in global sales make it the best-selling drug in history. The drugs are increasingly important in treating cancers and autoimmune diseases, such as rheumatoid arthritis and inflammatory bowel disease, that afflict about 1 in 10 Americans. health care spending, with their costs increasing 12.5% annually over the past five years. health care system, whose prescription drug coverage can be spotty and expenditures far more unequal than in other advanced economies.īiologics like Humira occupy a growing share of U.S. ![]() The ongoing saga of Humira - its peculiar appeal to drug middlemen and insurers, the patients who’ve benefited, the patients who’ve suffered as its list price jumped sixfold since 2003 - exemplifies the convoluted U.S. “We’re not seeing a lot of takeup of the biosimilar,” said Keith Athow, pharmacy director for Tennessee’s group insurance program, which covers 292,000 state and local employees and their dependents. That gives doctors and patients little incentive to switch. ![]() Express Scripts and Optum Rx, two of the three giant PBMs, have put biosimilars on their formularies, but at the same price as Humira. The business won’t work unless they gain significant market share, they say. While a manufacturer may need to spend a few million dollars to get a generic pill ready to market, makers of biosimilars say their development can require up to eight years and $200 million. “The percentage savings might be similar, but the total dollar savings are much bigger,” Holmes said, “as long as the plan sponsors, the employers, realize the opportunity.” Coherus BioSciences launched its Humira biosimilar, Yusimry, in July at $995 per two-syringe carton, compared with Humira’s $6,600 list price for a nearly identical product. That’s because biologics are much more expensive than pills and other formulations made through simpler chemical processes.įor example, after the first generics for the blockbuster anti-reflux drug Nexium hit the market in 2015, they cost around $10 a month, compared with Nexium’s $100 price tag. With dozens of biologics nearing the end of their patent protection in the next two decades, biosimilars could generate much higher savings than generics, said Paul Holmes, a partner at Williams Barber Morel who works with self-insured health plans. Biosimilars Are Cheaperīiologics - both the brand-name drugs and their imitators, or biosimilars - are made with living cells, such as yeast or bacteria. states, switched most of its patients to a biosimilar in February and expects to save $300 million this year alone. Kaiser Permanente, which oversees medical care for 12 million people in eight U.S.
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