CVS to remove Humira from reimbursement lists in biosimilar push

In a move to drive down customer costs, AbbVie’s blockbuster therapy will be replaced by cheaper biosimilars.

Robert Barrie January 04 2024

CVS Caremark, the pharmacy benefits management subsidiary of CVS Health, will drop AbbVie’s Humira (adalimumab) from its list of covered drugs.

As part of the move, the US pharmacy giant will instead offer biosimilars to save costs and expand options for patients.

Customers with Choice and Standard Opt Out commercial formularies, which are drug lists used by employers, unions, and health plans, will retain coverage for the drug, according to a 3 January press release.

CVS said the changes will be effective from 1 April, with customers able to transition to biosimilars without the need for a new authorisation.

The company highlighted the indistinguishable clinical difference between biosimilars and their reference products. The company also pointed to the importance of a competitive biosimilar market for cost savings for patients.

In the same statement, CVS stated that AbbVie has entered an agreement with CVS-owned Cordavis to produce a co-branded Humira, which is expected to launch in Q2 2024. Cordavis was launched by CVS last year as the company targeted a stake in the biosimilar market. According to CVS, the market is projected to grow to more than $100bn by 2029.

CVS Caremark president David Joyner said: “By preferring biosimilars that have a significantly lower list price than their reference product, CVS Caremark is putting our customers in the driver's seat to best meet the health care needs of their members and lower drug costs."

AbbVie’s blockbuster drug Humira is one of the best-selling prescription drugs. The anti-inflammatory drug, which was first approved in 2002, generated $21.2bn in global sales in 2022, as per AbbVie’s full-year 2022 financial results.  

AbbVie’s dominant market position has been challenged by the introduction of Humira biosimilars to the US market. There are currently nine Humira biosimilars on the US market. Pfizer, Boehringer Ingelheim, Coherus, Sandoz and Amgen have all launched their own versions of the drug in the past year after the expiration of AbbVie’s patent.

In July 2023, AbbVie reduced the magnitude of projected falling sales for Humira after the company secured favourable positions on insurance drug coverage lists amid competition.

A market forecast by GlobalData’s Pharmaceutical Intelligence Centre predicts 2025 global sales for Humira will nevertheless drop to $6.9bn.

GlobalData is the parent company of Pharmaceutical Technology.

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