Navitus Adds Biosimilar Amjevita to Formulary

Navitus will add Amgen’s Amjevita, a biosimilar of AbbVie’s arthritis drug Humira (adalimumab), to its formularies beginning in April 2023. Throughout 2023, Humira will remain on formulary to ensure benefit stability and minimal change for members currently on therapy, Brent Eberle, senior vice president, chief pharmacy officer, said in a blog post.

He indicated that the company would be accessing the product through the lower wholesale acquisition cost option. Amgen is making Amjevita available with two pricing options. The first is a 5% below the current Humira wholesale acquisition cost (WAC) $6,922 for a four-week supply, which is almost $90,000 annually. The second would be 55% below the current Humira list price.

“With the announcement of a low-cost (low wholesale acquisition cost) product, savings compared with Humira is possible,” Eberle said in his post. “Our teams will continue to monitor the situation as additional biosimilar market competition arrives this summer. As savings opportunity is identified, Navitus will assess adding other adalimumab biosimilar products to standard formularies. This is consistent with Navitus’ approach on other therapies.”

Related: Will the Biosimilar Amjevita Lower Costs?

Navitus’ assessment of Amjevita determined that a similar net price was seen between both the high-WAC/high-rebate product and the low-WAC product, Eberle told Formulary Watch.

“Because Navitus operates as a full pass-through pharmacy benefit manager, there is no incentive to create spread by preferring a high WAC/ high rebate product when net costs are the same,” he said “Our focus is on what offers the most benefit to our clients and members. Currently, that is the low-WAC Amjevita product.”

He said the lower WAC acknowledges the time value of money and supports lower upfront drug cost for plan sponsors, rather than spending more now and awaiting a rebate several months later.

Additionally, the low-WAC Amjevita product specifically lowers the out-of-pocket cost for members enrolled in high-deductible health plans and offers stability for members on-therapy. “In the event of a future decision to prefer other adalimumab biosimilar(s) that come to market, the low-cost product helps to maintain affordability until a member’s transition to an alternative preferred product,” Eberle said.

Meanwhile, EmpiRx Health said that in 2023, EmpiRx Health plans to cover two biosimilar alternatives to Humira as they come to market, but that won’t be Amjevita because it is a biosimilar of an earlier version of Humira. In 2018, AbbVie reformulated Humira and began offering a version that was higher concentration. According to PSG estimates, 80% of Humira utilization is high-concentration formulation.

“As we add biosimilar options, we will continue to cover Humira,” EmpiRx Health said. “This will give prescribing physicians options to switch to a new agent if they feel their patient is a candidate, while preventing gaps in care or disruption of therapy for those who are successful with Humira. It will also provide patients and providers with the time they need to get comfortable with a new device and product.”