Biosimilar Sales Up as Insurers Begin Dropping Humira Coverage

AbbVie has so far defended its majority market share among biologics for rheumatoid arthritis despite the loss of exclusivity for its flagship drug Humira (adalimumab). But for the first time since Humira biosimilars appeared last summer, the company’s dominance might be slipping as insurers change coverage policies.

This month, new prescriptions for Humira biosimilars surged 36% after pharmacy benefit manager CVS Caremark removed the AbbVie product from its major formularies in favor of biosimilars for reimbursement. Sandoz’s Hyrimoz accounted for 93% of that growth.

“We attribute much of the success Hyrimoz has had in the last few weeks to the formulary change, and we are building on this,” a Sandoz spokesperson told BioSpace. The spokesperson said the company is negotiating with other health insurers as well. “We are hopeful that the market will further open up in 2025, and we will see [other biosimilars] displace Humira.”

‘Center of the Storm’

Hyrimoz is seen as one of three main competitors to Humira. The drug is currently co-preferred with Humira on both Optum and Express Scripts national formularies and has a list price more than 80% below Humira’s. But despite the surge in Hyrimoz prescriptions over the past few weeks, Mizuho analyst Jared Holz said there haven’t been many changes to previous estimates of a 30%–50% loss of market share for AbbVie over five years after Humira’s loss of exclusivity.

So far, though, AbbVie has only lost 4% of the market to biosimilars, according to a February Samsung Bioepis report. The Big Pharma company has also made some strategic acquisitions to help offset the impact of Humira’s loss of exclusivity, Holz said. 

“The stock traded so poorly like three to five years ago, but now it’s benefited from having additional growth drivers,” he said, referring to AbbVie’s recent multibillion-dollar acquisitions of both ImmunoGen and Cerevel Therapeutics. These deals gave the company two new products, Rinvoq and Skyrizi, which AbbVie hopes will exceed peak revenues from Humira.

“[AbbVie] has done a great job of shifting the narrative to these two or three new products that they have in order to offset Humira,” Holz said. “It’s very clear that the company is strategizing to make sure that the decline of Humira is at least partially offset.”

AbbVie declined BioSpace's request for comment.

Holz said analysts are looking to see how the addition of other biosimilars impacts sales before they change their models. But he predicted that estimates will be lowered in late 2024 and into 2025 as existing Humira biosimilars capture more market share and additional options are approved.

With respect to the Inflation Reduction Act, Holz said AbbVie has less to worry about than other large pharmaceutical companies because its biggest drug is already being impacted by loss of exclusivity. “They’re in the center of the storm as we speak,” he said. “The impact that 2027 or 2028 [Medicare] pricing negotiations will have is probably less bad for AbbVie than others.”

Holz said he expects the real sales slump for Humira will happen more with new patients starting on the drug than with existing Humira users, as both patients taking Humira and their physicians may want to remain on the branded drug for continuity.

“My sense is that patients that have been on Humira for a while are going to attempt to stay on the drug because if they’ve had success taking it, their bias is positive,” Holz said. But he acknowledged that actions by health insurers and conversations prescribers have with their patients about cheaper alternatives do pose a threat to Humira's market share. 

Which Humira Biosimilars Will Rise to the Top?

It’s difficult to predict which biosimilar drugs will catch on, Holz said, as the drugs are “more similar than different.”

First, health insurance companies are going to look at the totality of data, including how the drugs are performing and whether they have worse side effects than competitors. Pricing strategies and rebates could also affect who rises to the top.

Ultimately, he thinks that existing relationships between pharmaceutical companies and payers will give some biosimilars a boost. If biosimilar makers have an established relationship with various Medicaid/Medicare agencies and commercial insurers, they will likely have an upper hand in receiving preference over Humira or other, unknown biosimilar creators, Holz said.

This essentially came into play with Hyrimoz and CVS, since the biosimilar is jointly marketed by CVS subsidiary Cordavis. With this arrangement, the pharmacy giant ultimately makes more money by shifting patients to a lower-cost alternative to Humira, according to a STAT News report. 

“When you talk about the fact that some of the competitors on the generic side are also household names . . . it makes it easier for some of the competition to get a bigger piece of the pie,” Holz said.

https://www.biospace.com/article/biosimilar-sales-up-as-insurers-begin-dropping-humira-coverage/