Amjevita, the first biosimilar competitor to Humira hit the U.S. market at the end of January. Showcasing the dysfunction of our healthcare delivery system, the copycat drug came to market with two drastically different list prices. One, a mere 5% discount relative to Humira and another with a 55% discount. Why two prices and who would pay for the more expensive option?
The dual pricing strategy echoes strategies of insulin biosimilars designed to optimize market uptake. On its recent earnings call, Amjevita’s manufacturer, Amgen, was unambiguous about its rationale for the dual-pricing strategy:
“With respect to the two list price approach that we've employed here at this launch, this is really to address the complexity of the U.S. market. Pharmacy benefit managers have a business model that requires that they negotiate rebates with manufacturers, and so they would prefer a high list price and negotiate rebates to net the price down and then pass those rebates through to their upstream employer clients.”
Thus we have two versions: 1) high-list/high-rebate 2) low-list/low-rebate
Most plans in the market will adopt the 1st version. Wise employers are the ones seeking the lowest net-cost approach and one that benefits all stakeholders, including their members (i.e. the patient). But, will Amjevita disrupt Humira’s $21 Billion reign?
Our recommendation is that employers consider adopting a targeted strategy:
Remove Humira from the formulary and replace it with Amjevita (55% discount version)
Patients already taking Humira will receive overrides to continue with Humira and be slowly nudged (and incentivized financially) to switch to Amjevita
Add step-therapy to therapeutic alternatives for Amjevita
More Humira copycat drugs will hit the market throughout 2023. Some will include the coveted “interchangeable” designation. Prudent employers will act now versus taking a wait-and-see approach. If your PBM pushes back on your ability to execute the steps above, reach out to us for help.
