UnitedHealth to remove AbbVie's Humira from some US drug reimbursement lists next year

Alvotech SA

10/09/2024 17:21

By Patrick  Wingrove
       Sept 10 (Reuters) - UnitedHealth Group  UNH.N  said on
Tuesday it will remove AbbVie’s  ABBV.N  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  AMGN.O  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.N  announced last month that it would remove
Humira from some of its lists in 2025, following similar action
by CVS Health's  CVS.N  Caremark unit in April. CVS's move led
more patients to switch to Sandoz's  SDZ.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  TEVA.TA  and Alvotech  ALVO.O  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  PFE.N .
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)
 ((Patrick.Wingrove@thomsonreuters.com;))