Despite 10 biosimilar versions of Humira (adalimumab) being available in the US market since 2023, their uptake has remained low. Humira retained 97% of its market share for adalimumab through to March 2024. However, now, a new form of partnership has allowed adalimumab biosimilars to increase their market share.
Some biosimilars launched both low-price and high-discount versions to compete with Humira, but this tactic failed to reduce Humira’s market dominance. However, in a new tactic, US’ CVS Caremark, a subsidiary of CVS Health and one of the country’s largest pharmacy benefit managers (PBMs), removed AbbVie’s Humira from its major national commercial formularies on 1 April 2024, in favour of biosimilar options [1]. In addition, Caremark launched Cordavis which would co-promote and commercialize Hyrimoz with Sandoz as well as the originator AbbVie’s Humira [2].
Early reports show that Hyrimoz market share rapidly increased after the formulary change, to 14% of adalimumab claims by April 2024 and 16% by June 2024, though not in Medicaid channels.
Additionally, a Cordavis version of Humira gained 5% of claims and 11% of new patients by June 2024. Express Scripts, another PBM, has adopted a similar approach, co-promoting Teva’s biosimilar and Humira with $0 out-of-pocket costs [3]. With major PBMs adopting co-promotion, traditional dominance by Humira may soon reduce.
It is important to note that, before Caremark launched Cordavis, most adalimumab biosimilar patients were new to treatment, and did not switch from Humira. This facilitated Humira’s patient retention. For example, in 2023, only 2% of treatment-naïve patients began adalimumab therapy with a biosimilar. By 2024, this grew to 14%, including biosimilars and Humira co-promotions. Despite this progress, Humira still dominates with ~86% of new patients receiving it in 2024.
Among biosimilars, most new starts come from patients switching from Humira. Few new biosimilar patients are treatment-naïve or switching from another biosimilar. Hyrimoz and its unbranded version, adalimumab-adaz, have the highest share of treatment-naïve patients after Humira. Switching trends may change as Quallent rolls out its co-promotion strategy [3].
It appears that, co-promotions, enabled by PBMs’ integration of specialty pharmacies, offer a new strategy that aligns the interests of innovators, biosimilars, and payers. PBMs also use specialty pharmacies to move volume through discounted co-promotions, providing biosimilars with access to large patient pools and allowing innovators to retain patients at a discount. Though this, patients can benefit from uninterrupted treatment and reduced cost-sharing.
Despite this, the long-term impact of co-promotions remains unclear. While they appear beneficial for stakeholders, it is uncertain whether healthcare systems and patients will see significant savings. Questions remain about the adoption of co-promotions across biosimilar drugs and their feasibility in systems like Medicare Part D. There’s also concern that co-promotions could limit competition by favouring select biosimilars, reducing aggressive discounting, and discouraging biosimilar development. Whether co-promotions become a standard strategy will depend on their outcomes for all parties involved.
Adalimumab is a human monoclonal antibody that treats autoimmune diseases by inhibiting tumour necrosis factor (TNF), a soluble inflammatory cytokine. Adalimumab binds to TNF-alpha (TNF-α), preventing it from activating TNF receptors, which cause the inflammatory reactions associated with autoimmune diseases. Adalimumab is indicated for the treatment of rheumatoid, juvenile idiopathic and psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, psoriasis and ulcerative colitis [4].
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References
1. GaBI Online - Generics and Biosimilars Initiative. CVS Caremark removes Humira in the US and Sandoz launches Hyrimoz in Europe [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2025 Jan 15]. Available from: www.gabionline.net/biosimilars/general/cvs-caremark-removes-humira-in-the-us-and-sandoz-launches-hyrimoz-in-europe
2. GaBI Online - Generics and Biosimilars Initiative. CVS’ Cordavis to launch Sandoz’s Hyrimoz (adalimumab) [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2025 Jan 15]. Available from: www.gabionline.net/biosimilars/general/cvs-cordavis-to-launch-sandoz-s-hyrimoz-adalimumab
3. GaBI Online - Generics and Biosimilars Initiative. US PBMs add multiple Humira biosimilars to formularies [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2025 Jan 15]. Available from: www.gabionline.net/biosimilars/general/us-pbms-add-multiple-humira-biosimilars-to-formularies
4. GaBI Online - Generics and Biosimilars Initiative. Biosimilars of adalimumab [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2025 Jan 15]. Available from: www.gabionline.net/biosimilars/general/biosimilars-of-adalimumab
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