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UnitedHealth to remove AbbVie's Humira from some US drug reimbursement lists next year
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UnitedHealth to remove AbbVie's Humira from some US drug reimbursement lists next year
Sep 11, 2024 12:05 AM

Sept 10 (Reuters) - UnitedHealth Group ( UNH ) said on

Tuesday it will remove AbbVie's ( ABBV ) 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 ( UNH ) said Amgen's ( AMGN ) 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 ( CI ) announced last month that it would remove

Humira from some of its lists in 2025, following similar action

by CVS Health's ( CVS ) 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 ( CI ) has said Boehringer Ingelheim's Cyltezo, Simlandi from

Teva and Alvotech ( ALVO ) and an unbranded version of

Sandoz's Hyrimoz will be covered on its lists in place of Humira

next year.

UnitedHealth ( UNH ) 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 ( ABBV ) 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 ( PFE ).

AbbVie ( ABBV ) 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 ( ABBV ) 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.

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