Blue Shield of California to Offer Humira Biosimilar Idacio

Blue Shield of California has signed an agreement with Fresenius Kabi for the adalimumab biosimilar Idacio to treat patients with chronic autoimmune diseases. The insurer said in a news release that it is purchasing Idacio (adalimumab-aacf) for a net price of $525 per monthly dose.

Additionally, starting on Jan. 1, 2025, most Blue Shield commercial members using Fresenius Kabi’s adalimumab-aacf will pay $0 out of pocket. Idacio is available in a self-administered pre-filled syringe and a self-administered pre-filled pen, and it is a citrate-free formulation.

Blue Shield of California, which worked with Evio Pharmacy Solutions to facilitate the deal for Idacio, last year launched a new model for pharmacy benefits. Called Pharmacy Care Reimagined, unbundled the traditional services of a pharmacy benefit manager (PBM) into five different areas. 

Related: Blue Shield of California to Save $500 Million with New Pharmacy Program

Paul Markovich

“We will no longer take part in a pharmacy system that is designed to maximize the profit of participants instead of the quality, convenience and cost-effectiveness for consumers,” Paul Markovich, CEO, Blue Shield of California, said in the news release. “Every employer, health plan and payer should be asking — and challenging — their pharmacy benefit managers to offer clinically effective and lower cost alternatives at a transparent price. This is why Blue Shield decided to rebuild our pharmacy care system — so we can get medications to the right people, at the right time, at the right price.”

The plan’s Pharmacy Care Reimagined program now includes eight partners to develop a different strategy for managing drug costs and providing access. The collaboration across Blue Shield of California, Fresenius Kabi and Evio Pharmacy Solutions marks the first time this business model has been used to bring a Humira biosimilar to patients. Evio is working with Blue Shield to negotiate directly with drug manufacturers to value/outcomes based arrangements.

Blue Shield said in its news release that it spends more on Humira than any other drug for its members, processing about 40,000 Humira prescriptions annually. But, the insurer said, that the 10 FDA-approved Humira biosimilars and additional unbranded products that have become available have not had much impact on bringing down costs.

An analysis from Drug Channels Institute provides more insight into the dynamics of this complicated market. Many of the Humira biosimilars were launched with two different prices, and several PBMs are offering their own private label versions. But many plans are still focused on the higher rebates that come with the higher list price biosimilars.

“Humira has drawn scrutiny for its high and inconsistent pricing from both consumers and policymakers,” said Matt Gibbs, vice president of pharmacy transformation at Blue Shield of California. “With our new low-cost alternative, Blue Shield offers a more affordable, yet equally clinically effective option to members and employers. This move continues our organization’s path of transparency and transforming pharmacy care for the better.”