At Univera Healthcare, we are proud to lead the insurance industry in pursuing biosimilars for our health plan members. Biosimilars are safe and effective treatment options and can be provided at a lower cost. Univera Healthcare was the first stand-alone health plan to prefer a biosimilar in the Infliximab category in 2018.
Univera Healthcare has educated many stakeholders throughout the U.S. on how to implement a successful biosimilar program, and we’ll continue to do so in the future, as more and more biosimilars are approved by the FDA* and brought to market.
Effective September 1, 2023, Univera Healthcare will add two HUMIRA® biosimilars to our custom formularies that are preferred medications alongside Humira. Univera Healthcare will offer:
- Boehringer Ingelheim’s CYLTEZO, which is available in low concentration, and
- Organon’s HADLIMA™, available in high and low concentrations.
Univera Healthcare chose these biosimilars after extensive clinical review. There are now 11 biosimilar options in the Humira category, offered by eight manufacturers, with more Humira biosimilars in the pipeline. We’re confident our strategy will maximize provider and member opportunities to convert to a biosimilar if desired.
Concentration: >85% national market share is in the high concentration. Hadlima is a high-concentration formulation.
Interchangeability: Cyltezo is the only biosimilar that is interchangeable with Humira. Interchangeable status allows pharmacists to convert brand Humira prescriptions to the biosimilar without contacting the prescriber in advance.
Auto-injector: Both Cyltezo and Hadlima are available in an easy-to-use auto-injector.
Pediatric Dosing/Starter Kits: Cyltezo is available in pediatric dosing and starter kits.
Clinical Studies: Most of the biosimilars share the same FDA approved indications; however, the number of pivotal studies varies per manufacturer. Cyltezo was the only biosimilar that had a pivotal study in Crohn’s disease. Our historical experience has shown that gastroenterologists are the most hesitant prescriber specialty to switch to biosimilars and having a study in gastroenterology space may alleviate their concerns.
Low WAC: Hadlima’s low WAC may be preferable for those members with co-insurance and HDHP plans.
Naming Convention: Some manufacturers have adopted a dual pricing strategy with both a high WAC and low WAC version of the same biosimilar. This pricing strategy causes confusion for providers and pharmacists on what to prescribe and dispense.
Offering these two preferred biosimilars will increase biosimilar use and decrease costs, while maintaining safe and effective low-cost options for our group members.
Read our press release to learn more and share this exciting information with your employees today.
