Blue Shield of California will pay $525 per monthly dose of the biosimilar, compared to the typical market reported net price of Humira of $2,100, according to an Oct. 1 news release from the insurer.
Here are five things to know about the deal:
- Evio Pharmacy Solutions, a company backed by several Blue Cross Blue Shield plans, negotiated the deal.
- Most Blue Shield commercial members will pay nothing out of pocket for Fresenius’ biosimilar. The move is expected to improve medication adherence, Blue Shield of California said.
- Blue Shield of California spends more on Humira than any other drug, according to the release. Humira, used to treat rheumatoid arthritis and other inflammatory conditions, is the highest-grossing drug of all time.
- Biosimilar competitors to Humira, introduced in 2023, cost less than the original biologic, but the transition has been slow, the release said.
- CVS Caremark removed Humira from most formularies in April. Express Scripts and Optum Rx will follow suit in 2025.
- In 2023, Blue Shield of California announced it would unbundle its PBM services, including limiting its yearslong partnership with CVS Caremark. Blue Shield of California uses Mark Cuban Cost Plus Drug Co. and Amazon Pharmacy as its preferred pharmacy networks.
- Evio Pharmacy Solutions has similar arrangements for a number of biosimilars in the works, according to an Oct. 1 news release from the company.