Cigna Healthcare Boosts Treatment Access with New Biosimilar Coverage
By covering the Humira biosimilars, Cigna Healthcare aims to promote competition that will generate lower prescription drug costs.
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- Cigna Healthcare has added four Humira biosimilars to its formularies, aiming to increase member access to affordable treatments.
Cigna Pharmacy Management, Cigna’s provider of pharmacy benefits, will include the biosimilars as preferred products on its formularies.
“Cigna Healthcare is committed to driving greater value and lower costs where clinically appropriate for our customers and clients, and expanding access to treatment options for people that need specialty medications is core to that commitment,” Katy Wong, chief pharmacy officer of Cigna Pharmacy Management, said in the press release.
“By placing clinically effective biosimilars on our formularies in the same position as HUMIRA, we’re ensuring that physicians and patients have choice and flexibility, as well as lower health care costs through healthy competition.”
Primarily used to treat rheumatoid arthritis and other inflammatory conditions, Humira can be a costly drug, even for those with health insurance.
Starting on September 1, 2023, Cigna Healthcare will add the following Humira biosimilars to its national, preferred, standard, performance, and legacy commercial formularies:
- Cyltezo (Boehringer Ingelheim), the first FDA-approved interchangeable biosimilar to HUMIRA, low-concentration formulation
- Adalimumab-adaz (Sandoz), high-concentration formulation, unbranded
- Hyrimoz (Sandoz), high-concentration formulation
Cigna Healthcare will also include the high- and low-concentration formulations of Hadlima (Organon) to its value, advantage, and total savings formularies.
Cigna Pharmacy Management announced its plans to add the biosimilars to its formularies in 2022. The payer expects Cigna Healthcare integrated clients that use Cigna Pharmacy Management for pharmacy benefits to see significant savings as a result of the additions.
The Cigna Group’s health services business Evernorth projected that the competition from biosimilars could save the country $225 billion to $375 billion in total pharmacy spending over the next ten years.
Provisions included in the Inflation Reduction Act aim to promote the use of biosimilars to compete with biological products and reduce healthcare costs. Medicare typically pays the average sales price (ASP) plus six percent for a biosimilar product.
Under the Act, biosimilars with an ASP equal to or below the reference biological price will be available for the biological reference products’ ASP plus eight percent for the next five years.
As prescription medication costs rise, biosimilar adoption could help minimize the effects of the high prices. Although including biosimilars in pharmacy benefits may come with challenges, particularly for employers, working with health plans and pharmacy benefit managers can help facilitate adoption, according to the National Alliance of Healthcare Purchaser Coalitions (National Alliance).
