By Patrick Wingrove
(Reuters) – UnitedHealth Group said on Tuesday it will remove AbbVie’s blockbuster rheumatoid arthritis drug Humira from some of its lists of preferred drugs for reimbursement as of Jan. 1, 2025, and recommend less expensive biosimilar versions of the medicine instead.
UnitedHealth said Amgen’s Amjevita will be among the biosimilars covered on its lists for commercial health plans, which are managed by its pharmacy benefits unit, Optum Rx.
Optum is the last of the three largest U.S. pharmacy benefits managers to announce Humira’s exclusion. The three benefits managers together control around 80% of the U.S. prescription drug market.
Cigna announced last month that it would remove Humira from some of its lists in 2025, following similar action by CVS Health’s Caremark unit in April. CVS’s move led more patients to switch to Sandoz’s biosimilar version of Humira in three weeks than had switched in the prior 15 months.
Cigna has said Boehringer Ingelheim’s Cyltezo, Simlandi from Teva and Alvotech and an unbranded version of Sandoz’s Hyrimoz will be covered on its lists in place of Humira next year.
UnitedHealth said patients will have a way to get coverage for Humira until the preferred biosimilars on its plans are designated interchangeable by the U.S. Food and Drug Administration, meaning they can be substituted for the original without consulting the prescriber. The FDA is expected to grant that designation in 2025, United said.
The U.S. Federal Trade Commission in July criticized pharmacy benefit managers, which negotiate fees and volume-based discounts on behalf of payers with drugmakers and pharmacies, for exercising outsized influence over prescription drug prices.
The Pharmaceutical Care Management Association – an industry lobbying group – said in response that the companies provide value to the U.S. health system by reducing prescription drug costs and increasing access to medicines.
AbbVie has retained most of the U.S. market for Humira this year, despite the launch of 10 biosimilar alternatives to the drug since January 2023 from companies including Pfizer. AbbVie negotiated favorable positions on insurance drug coverage lists managed by pharmacy benefits managers.
The U.S. market share for Humira biosimilars stands at nearly 20%, compared with 2.2% in the first quarter of this year, Barclays analysts said in a note on Monday.
AbbVie did not immediately respond to a request for comment, but said earlier this year that it expects to retain a lower share of the Humira market in 2025.
(Reporting by Patrick Wingrove in New York; Editing by Matthew Lewis)
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