In a message to providers, Optum said it will exclude Humira and prefer biosimilar options for new patients beginning in 2025.
Existing patients will be able to continue on Humira until the FDA designates biosimilars as interchangeable with Humira, meaning they can be substituted at the pharmacy without consulting the prescriber. The designation is expected in 2025.
In August, Express Scripts, Cigna’s PBM, said it will remove Humira from its largest commercial formularies in 2025.
Humira, used to treat rheumatoid arthritis and other inflammatory conditions, is the highest-grossing drug of all time. Biosimilar competitors to the drug can cost less, though the transition has been slow, according to a 2023 report from KFF Health News.
CVS Caremark was the first major PBM to replace Humira with biosimilars from its main formularies. The company dropped Humira from its formularies in April. After instituting the change, 97% of Caremark member prescriptions were switched to a preferred biosimilar, the company said.
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