Delivering the Promise of Biosimilars: Lower Costs, Broad Access, Comprehensive Care
At CVS Health , our journey is defined by innovation and a commitment to clients and members. Our most recent example is the work we are doing, accelerated by CVS Caremark , to develop a robust biosimilar market. We lead the market in navigating coverage for and driving adoption of biosimilars, as these safe and clinically effective treatment options come to market.
In my 30 years in this industry, there have been watershed moments where pharmacy benefit managers (PBMs) drive meaningful change. Whether accelerating the wave of generics for blockbuster drugs in the early 2000s, putting curative therapies for Hepatitis C within reach of patients in the 2010s, or delivering on the promise of biosimilars today, CVS Caremark is front and center, and I am proud of the work we do and the innovation we continue to drive.
?CVS Caremark is the first—and so far, the only—PBM to remove Humira from our major national commercial template formularies and continue to include preferred low-list price biosimilar options. You likely saw a rapid uptake of biosimilars following our April 1 formulary implementation, but that moment resulted from a thoughtful approach, extensive planning, deep analysis based on client and patient needs, and a comprehensive strategy to drive down costs without compromising on quality or continuity of care.?
I’m excited to share updates on our leadership in driving biosimilars and utilization, and the shared success we’ve seen with biosimilar prescribing and usage for CVS Caremark clients and their plan members.
Taking Bold Actions to Drive Down Costs
The results speak volumes. In the first three weeks following this strategic shift, 93% of Humira (adalimumab) scripts were filled with a preferred biosimilar, demonstrating rapid adoption. This is a testament to the need for these medications, our industry-leading formulary strategies and the unmatched clinical support we provide. We are educating the market and leading by example.
?93% of adalimumab scripts were filled with a preferred biosimilar
Clients who remained on the standard commercial template formulary have realized $140 million in gross savings in the first three weeks of April 2024. Additionally, for these plans that utilize intelligent benefit design, members experienced a $0 out-of-pocket cost for preferred biosimilars.
This achievement represents more than just financial savings; it’s a step forward in redesigning the pharmaceutical landscape, ensuring that clinically effective medications are accessible and affordable.
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Advancing our Commitment to Patients and Providers
We’ve paired our formulary strategy with industry-leading clinical therapy management, education, and administrative support, helping members and their prescribers navigate this transition. We implemented innovative technology solutions to make it simpler for providers to select covered alternatives to Humira with a single click.
Prior to the updates to our formularies, we shared resources with plan members and their prescribers to help them understand what the changes meant, how it would impact them, and simple instructions to make the transition as seamless as possible.
Leading Through Innovation
In 2017, we became the first PBM to add a biosimilar to our formulary, recognizing the potential of these biologic alternatives to drive down prescription drug costs. We haven’t stopped since then. The introduction of CVS Health subsidiary Cordavis, which works directly with manufacturers to commercialize and/or co-produce biosimilar products, has provided another mechanism to support the biosimilar market. Our first Cordavis biosimilar product, a co-branded version of Hyrimoz, is now in market and available to patients.
By driving biosimilar adoption, we not only support the market's transition towards more cost-effective treatment options but also incentivize the development and approval of additional biosimilar products.
Our strategic foresight, combined with a commitment to patient care and cost reduction, is redefining the future of health care.
Source: CVS Health Analytics, 2024. CVS Commercial clients Jan 2024 – Apr 2024.? All data sharing complies with applicable law, our information firewall and any applicable contractual limitations. Savings projections are based on CVS Caremark data. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors.
Patient care and cost reduction but at what cost? Patients need to be informed immediately of any use of unauthorized tools. https://www.dhirubhai.net/posts/philip-morisky_informedconsent-activity-7201617914175655936-yXv6?utm_source=share&utm_medium=member_ios
Inventory Specialist and Advanced Certified Pharmacy Technician at CVS Pharmacy
6 个月David Joyner how is forcing a patient to get 30 days of Linzess instead of 90 days when Linzess co-pay card makes it the same price either way a cost savings for patients?! How is not having IBS medications that are generic on formulary a cost savings for patients?! CVS Caremark
Operating Room Circulator/Nurse
6 个月What does any of that matter, if your customers cannot get customer service to do something as simple as filling a prescription. I’m a nurse, and I’ve been trying for two weeks to have my medication filled. You can’t reach a human being but only leave a message to get help. So I left a message asking why my prescription hadn’t been filled. I received no response, so two days later I called again and stated that I was going to be coming by later that day to get an update on my medication. That afternoon when the pharmacist finally called me back she said that they hadn’t had that generic medication in stock for two months, and that “all doctors know this.“ But they did have the namebrand in stock, and so I asked them if they would fill that. CVS Caremark wanted prior authorization for this medication that I’ve been on for 12 years, but say they’ll send that right over to my doctors office. The next day I speak with my doctors office and they did not receive it. It is now a week later, and we have gone back-and-forth between Caremark and my doctors office, my doctors office saying they still have not received anything from Caremark or CVS. Meanwhile I have gone over two weeks without my medication.
Retired
6 个月And what are the NDCs of biosimilars youuse v. Humira? And what is the WAC and AWP pricing for each of those biosimilars? And will you suddenly price these “generic” biosimilars as brands? It’s happened before!! Please explain on this LinkedIn post so we can see your answer?
CEO at VIVIO, A Public Benefit Corporation
6 个月You have got to be kidding me! This isn't 'strategic foresight' rather plain and simple market manipulation which increases profitability for CVS and drives up costs for every American. The market spoke and there were and are much lower cost biosimilars available without a rebate from manufacturers like Coherus BioSciences. Your customers are really the street and Pharma, not the people who are your members. If they were, then you wouldn't be making employers and employees pay more for the same outcome. Do people really believe this stuff? It kinda violates commonsense. Prove me wrong easily, CVS Health and David Joyner, publish your net prices for your branded biosimilars publicly. There is nothing that I would like better than to be proven wrong in this case.