Catching the biosimilar wave

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The biosimilar boom. Autoimmune conditions are traditionally treated with expensive biologic medications. But with the influx of affordable biosimilar treatments hitting the market, coverage doesn’t have to break the bank. CVS Caremark strategically balances name-brand biologics with biosimilars to get patients lifesaving medications at a lower cost. Learn more.

The global anti-inflammatory biologics market is having its moment. It’s projected to reach nearly $150b by 20271—and with that kind of growth comes a whole lot of innovation.

The other big news? The healthcare marketplace anticipates a wave of biosimilars in the autoimmune category, which will help bring down costs for patients and plan sponsors alike. That means providers can continue prescribing high-quality, sustainable care without breaking the bank.

CVS Caremark is leading the charge in creating comprehensive, thoughtful coverage of biosimilars. Their team of experts helps keep costs down (and outcomes positive) by providing clients with innovative formulary strategies as the biosimilar market booms.

Let’s dig into what’s going on in the world of biosimilars—and how CVS’s formulary considerations are a game changer.

What are biosimilars?

Let’s start with the basics. Biologics, also called brand biologics or reference products, are large, complex molecules derived from living cells or organisms used in medications treating autoimmune diseases and other chronic conditions.

What, exactly, do these biologics do? Great question. As we mentioned, biologics are often used in the treatment of certain autoimmune conditions. In fact, autoimmune-related treatments are the No. 1 cost for plan sponsors. Biologic treatment costs for just one member can reach hundreds of thousands of dollars each year. (Yikes.) And while autoimmune conditions affect only 1% of commercially insured plan members, they accounted for 42% of specialty spend in 2022.2 Luckily, a wave of new biosimilars is hitting the market in a big way.

Biosimilar drugs are very similar to their FDA-approved brand biologic counterparts, with no clinically meaningful differences in safety or effectiveness. This makes them more affordable for plan sponsors and patients alike.

The wave begins

Approximately 100 products treating autoimmune diseases are currently in preclinical and clinical development.3 New biosimilars will also treat ophthalmic, immunologic, and musculoskeletal conditions, bringing the global biosimilars market to $30b by 2025..4

This robust pipeline comes with opportunities to lower the costs of autoimmune medications, which means significant savings for plan sponsors. Cha-ching!

And there’s some healthy competition in the market, too. CVS Caremark found that as biosimilars enter the market, costs are driven down for both the biologic reference medication and the biosimilars themselves—another score for plan sponsors.

Let’s talk formulary considerations

Lower costs sound great, but what does it take to actually provide high-quality biosimilars without sacrificing care or going way over budget?

Truthfully, it takes a lot of thoughtful consideration. The CVS Caremark team examines multiple factors to help balance brand biologics and their biosimilar counterparts to ensure that patients have coverage for more affordable, lifesaving medications.

Each biosimilar’s features are evaluated critically. To better understand how new biosimilars might impact adoption by providers and patients, CVS reviews:

• formulation
• delivery mechanism
• adequate supply
• member experience

In addition to understanding the attributes of each biosimilar, CVS also explores the complex relationships between clinical appropriateness, efficacy, and price. How well does each biosimilar replicate the strengths, forms, and indications of the reference biologic? Can it provide clinically effective coverage at the lowest possible cost?

CVS Caremark drives the lowest net cost in the category by considering utilization and overall product price. This results in a combination of reference biologics, biosimilar competitors, and other branded products working together to create effective coverage for patients.

Learn more about how CVS Caremark empowers plan sponsors to provide excellent coverage at a lower cost.