USA —The world of arthritis treatments in the U.S. is witnessing a transformative shift as seven drugmakers introduce their biosimilar versions of AbbVie’s flagship drug Humira, a widely used and expensive medication.
Healthcare experts predict that this development will lead to increased scrutiny of the middlemen responsible for negotiating drug prices for most insured Americans – the pharmacy benefit managers (PBMs).
The biosimilars come with various pricing strategies, with some priced at a significant 85% discount compared to the original drug, while others remain within 5%-7% of AbbVie’s price.
This dynamic is sparking further interest from lawmakers and the federal government, who are already investigating the role of PBMs in healthcare costs.
While the availability of competing versions of a drug usually leads to a drop in prices, biosimilars have shown a different pattern, with complex biotech drugs like Humira experiencing a less significant price decline.
Despite the robust competition, the list prices of Humira and its biosimilars remain high, leaving insured patients with only minimal savings, considering the 10% to 25% co-pays they often face.
The Biden administration has prioritized efforts to lower drug prices, and the Inflation Reduction Act marked the first U.S. drug pricing legislation passed last year.
Now, the focus is on PBMs, the key players in drug pricing negotiations. Lawmakers and the Federal Trade Commission (FTC) are delving into PBM operations, with pending bills seeking greater transparency in their business dealings, including disclosure of fees earned on transactions.
The three major PBMs, CVS Health’s Caremark, Cigna Group’s Express Scripts, and UnitedHealth Group’s Optum RX, are at the center of this scrutiny but have so far declined to comment.
PBMs argue that they play an essential role in controlling drug costs for their clients, including employers and health insurance plans, and that most after-market discounts benefit their customers.
Amid this shift in drug pricing, the launch of Amjevita, a near copy of Humira by Amgen, brought attention to the middlemen.
Amgen introduced two pricing options, showcasing how PBMs prefer higher list prices to garner after-market discounts, while patients face low co-pays or favorable coverage terms. However, the adoption of lower-priced biosimilars by patients remains low.
Experts in the U.S. healthcare system emphasize that although the market change could lead to significant savings for consumers, it may take time for the proposals to materialize.
Stricter regulations on PBM operations, including charge determination restrictions and reimagined business models, may help address the transparency and accountability challenges.
As the biosimilar revolution shakes up the arthritis drug market, questions about the benefits of rebates and the impact on local pharmacists and consumers continue to be raised.
The call for reform in the pharmaceutical supply chain intensifies as the industry undergoes a transformative and critical period.
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