Cigna to Drop AbbVie’s Humira from Preferred Drug Lists in 2025, Favoring Lower-Cost Biosimilars

103

Cigna, a leading health insurance provider, announced on Monday that it plans to remove AbbVie’s blockbuster rheumatoid arthritis drug, Humira, from some of its preferred drug lists for reimbursement starting in 2025. Instead, the company will recommend more affordable biosimilar versions of the medication, a move expected to significantly impact the market dynamics for this widely used treatment.

Beginning in 2025, Cigna’s pharmacy benefits unit, Express Scripts, will start covering biosimilars such as Boehringer Ingelheim’s Cyltezo, Simlandi from Teva, an unbranded version of Hyrimoz from Sandoz, and biosimilars from Alvotech on select formularies. These alternatives are set to replace Humira on certain drug lists managed by Express Scripts, marking a significant shift in Cigna’s approach to managing drug costs.

This decision by Cigna follows a similar move by CVS Health’s Caremark unit, which earlier this year stopped recommending Humira in favor of its biosimilars. The CVS decision led to a dramatic increase in the number of patients switching to biosimilar versions of Humira within just three weeks—a greater shift than had occurred over the previous 15 months combined.

AbbVie, the pharmaceutical giant behind Humira, has not yet responded to Cigna’s announcement. However, the company has previously acknowledged that it expects to see a reduced share of the Humira market next year as competition from biosimilars intensifies.

Pharmacy benefit managers (PBMs) like Express Scripts and Caremark serve as intermediaries between drug manufacturers and consumers, negotiating discounts and fees on behalf of insurance companies and patients. These PBMs have come under increasing scrutiny from U.S. lawmakers and regulatory agencies for their perceived role in maintaining high drug prices. While PBMs argue that they help reduce drug costs through their negotiations, critics contend that they contribute to the complexity and expense of the pharmaceutical market.

Despite the introduction of 10 Humira biosimilars in the U.S. since January 2023 from companies like Amgen and Pfizer, AbbVie has managed to maintain a dominant position in the market. The company has done so by securing favorable placement on the drug coverage lists managed by PBMs, allowing it to retain a significant market share even in the face of competition.

Humira, which once held the title of the world’s best-selling prescription drug, reached peak sales of $21.2 billion in 2022. This dominance was partially due to its strong presence on insurance formularies, supported by agreements with major PBMs.

As of 2023 and 2024, Express Scripts and Optum Rx, another major PBM under UnitedHealth Group, decided to keep Humira on their reimbursement lists. However, with Cigna’s new policy set to take effect in 2025, there could be a further shift in the market landscape as other PBMs may follow suit.

In an effort to remain competitive, Cigna introduced a program in June 2023 that allowed U.S. patients eligible for specialty pharmacy services to access Humira biosimilars with no out-of-pocket costs. Despite this initiative, AbbVie managed to retain virtually all of its market share, indicating the strength of its established position.

Optum Rx has not yet commented on whether it plans to remove Humira from its reimbursement lists in 2025, leaving room for further developments in the ongoing competition between brand-name drugs and their biosimilar counterparts.

Cigna’s decision to phase out Humira from its preferred drug lists represents a broader trend in the healthcare industry, where cost-effective biosimilars are increasingly being favored over more expensive brand-name drugs. This move is likely to have far-reaching implications for patients, healthcare providers, and the pharmaceutical industry as a whole, as the battle for market share in the rheumatoid arthritis drug market intensifies.