America's Benefit Specialist November 2023

efit. That changed in July 2021, with the launch of the first interchangeable biologic version of insulin, SEMGLEE (insulin glargine). Pharmacy benefit managers leverage discounts among products with similar therapeutic profiles to deliver lower net prices for their clients. Plan sponsors use rebate revenues to lower premium costs for all plan members, including those who may not take many (or any) prescription drugs. However, manufacturers may increase their list prices to negotiate larger rebates, which increases out-of-pocket costs for patients taking the medication when cost-sharing is calculated off the drug’s list price. Rebates in the pharmacy benefit space appear to be a factor in blocking patient access to biosimilars covered under a plan’s pharmacy benefit. SEMGLEE launched at a discount as much as 65% off the list price of its branded biologic, LAN TUS. PBMs have consistently chosen to cover LANTUS in the commercial and Medicare Part D market, even though most prescriptions for insulin glargine are currently being written for one of the biosimilars. 6 In February 2023, AMJEVITA (adalimumab-atto), the first biosimilar version of HUMIRA (adalimumab), launched with one product offered at a five-percent discount off HUMIRA’s list price (with a higher rebate), and a second product was offered at a 55% discount (with no rebate) .7 In June 2023, Coherus, manufacturers of YUSIMRY (adalimumab-aqvh), announced a partnership with Mark Cuban’s Cost Plus Drug Company to distribute their biosimilar version at an 85% dis count off HUMIRA’s list price. 8

$129 billion. 4 Two biologic drugs selected for negotiation un der the Medicare Drug Negotiation Program (NovoLog and STELARA) are also expected to gain biosimilar competition before 2026. 5 HOW ARE MANUFACTURERS PRICING BIOSIMILARS FOR THE PHARMACY BENEFIT? Prior to 2021, biosimilar launches were concentrated on molecules generally covered under a plan’s medical ben

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