This comes as a result of an innovative direct purchase agreement with Evio Pharmacy Solutions and drug manufacturer Fresenius Kabi. This eliminates the markups often found in a traditional pharmacy benefit manager model. Now, Blue Shield’s new Pharmacy Care Reimagined model allows the nonprofit health plan to provide its members with better access to biosimilar medications.

When it comes to biosimilars, which are supposed to facilitate access to lower-priced treatment options, complex pharmacy value chains can create barriers and misaligned incentives for uptake. However, now, Evio’s alternative payment model eliminates traditional rebate strategies and transparently aligns incentives between health plans and manufacturers to unlock the value of biosimilars.

From 1 January 2025, most Blue Shield commercial members using Fresenius Kabi’s adalimumab biosimilar will pay US$0 out of pocket. Overall, this will bring drug spend down and it is expected to increase medication. This will be a benefit in terms of care cost and member health outcomes.

‘This agreement will have transformational economic impact for Evio customer health plans and their members,’ said Matt Seibt, Head of Pharmaceutical Partnerships at Evio, who led the strategy and negotiations. ‘Evio is perfectly positioned to play an integral role in the adoption of biosimilars, and given the coming biosimilar wave, we are actively working on similar arrangements for a number of biosimilars in the pipeline.’

Adalimumab is a human monoclonal antibody treats autoimmune diseases including rheumatoid arthritis, juvenile idiopathic and psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, psoriasis, and ulcerative colitis [1].

Despite the availability of several adalimumab biosimilars in the US, the originator product, Humira, retains a large portion of patients [2]. This new agreement hopes to change the landscape for this treatment option.

Related article
FDA approves interchangeable adalimumab biosimilar Simlandi

References
1. GaBI Online - Generics and Biosimilars Initiative. Biosimilars of adalimumab [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2024 Oct 15]. Available from: www.gabionline.net/biosimilars/general/biosimilars-of-adalimumab
2. GaBI Online - Generics and Biosimilars Initiative. Humira's resilience in the face of biosimilar competition [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2024 Oct 15]. Available from: www.gabionline.net/biosimilars/general/humira-s-resilience-in-the-face-of-biosimilar-competition

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