Beginning Jan. 1, 2025, Optum Rx will prefer a different set of Humira biosimilar on its commercial formularies. UnitedHealth Group’s pharmacy benefit manager (PBM), one of the three largest in the United States, is favoring Amgen’s Amjevita (adalimumab-atto) over Sandoz’s Hyrimoz (adalimumab-adaz) and Cyltezo (adalimumab-adbm).

Optum Rx still includes Humira (adalimumab) on its formulary, as a tier three product, and Amjevita the first Humira biosimilar to be launched in January 2023, is a tier two product. Both Humira and Amjevita are subject to prior authorization and quantity limits. Optum Rx is removing Hyrimoz, Cyltezo and the nonbranded adalimumab-adaz, based on a review by Formulary Watch of Optum Rx’s Select Standard Formulary effective Jan. 1, 2025, compared with January 2024 list. (See Table below)

The preferred adalimumab biosimilars will include high-WAC (wholesale acquisition cost) and low-WAC Amjevita, with high-concentration doses, including formulations appropriate for pediatric patients, and access to all drug strengths. The high-WAC products provide rebates to insurers and employers.

“The decision addresses affordability for patients, including availability of manufacturer copay assistance programs, and significant cost reduction for plan sponsors,” an Optum Rx spokesperson said. “We will offer a path to coverage for those patients who require Humira for clinical reasons.”

Biosimilars have made headway in the U.S. market, delivering on their stated purpose of bringing down the cost of expensive biologics by creating competition to their brand-name reference drugs. But Humira biosimilars, with now 10 available on the market, crucial test of biosimilar market because Humira had the top selling prescription brand-name drug for years.

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Initially, the sale of the Humira biosimilars was small as insurers and PBMs continue to include Humira on their formularies. Many Humira biosimilar manufacturers used a dual pricing strategy, with both high-WAC and low-WAC options. Although the low WAC prices were on average 81% lower than Humira’s price, at the end of 2023, there was only 3% adoption of biosimilars, experts have said. At least one study has found that switching to the Humira biosimilars can resulted in overall cost savings.

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Now the tides turning, and some large PBMs have started to remove Humira from their formularies in favor of biosimilars. CVS Health and Evernorth, for example, have said that they would teaming up with manufacturers to launch private label versions of the biosimilar. In 2023, for example, CVS launched Cordavis, which company officials said was a way to accelerate adoption of biosimilars and bring cost savings to payers and patients. The company also said Cordavis allows for manufacturing oversight and provides quality assurance.

But Adam Fein of Drug Channels had speculated at the time that CVS Health was positioning itself for the 2025 Medicare part D market. Because of the Inflation Reduction Act, Fein said that high-list, high-rebate drugs may be less attractive.

Beyond biosimilars

Optum Rx has added several oncology medications to its formulary, including Augtyro (repotrectinib), a Bristol Myers Squibb drug that is used to treat patients with ROS1-positive non-small cell lung cancer and patients with solid tumors that have a NTRK gene fusion. For 2025, Augtyro will be a tier three specialty medication that requires prior authorization.

Another added oncology therapy is Truqap (capivasertib), which was approved in November 2023 to treat patients with HR-positive, HER2-negative locally advanced or metastatic breast cancer. It was developed by Astek Pharmaceuticals and partner AstraZeneca. Trugap will be a tier three specialty medication that requires prior authorization.

But the PBM has removed for 2025 Kisqali Femara, which is ribociclib and letrolzole packaged together, from its 2025 formulary. Like Kisqali (which is on Optum Rx’s formulary list), Kisqali Femara is a treatment for early metastatic HR-positive, HER2-negative breast cancer. Femara is a hormone and reduces the amount of estrogen in the body and is approved as first line for women in breast cancer.

Among the drugs for central nervous system disorders, Optum Rx has added Abilify Asimtufii (aripiprazole) as a tier three product. Previously only Abilify Maintena and generic aripiprazole were included. Abilify Asimtufii (aripiprazole) and Abilify Maintena are long-acting maintenance treatments developed by Otsuka and Lundbeck.

Optum Rx has included for 2025 MedinCell’s Uzedy (risperidone) extended-release injectable suspension, a subcutaneous, long-acting formulation of risperidone that uses SteadyTeq, which is able provide for the steady release of risperidone. It is a tier 3 product.

Optum Rx 2025 Biosimilar Changes