Humira® biosimilars in focus

For years, Humira® (adalimumab) has been a significant driver of healthcare costs due to its high price and utilization. With the introduction of several Humira biosimilars and interchangeable options in 2024, ClearScript has been carefully monitoring the landscape and adapting our strategies to ensure members have access to effective therapy options that improve health and lower costs.

2025 Humira Biosimilar Strategy
Beginning January 1, 2025, ClearScript is taking further measures to control drug spend in this costly category, while avoiding disruption to members currently stable on therapy.
• Expanded Access for Members New to Therapy: We are expanding access to two Humira biosimilars, Simlandi and “unbranded” adalimumab-adaz, as the preferred products for members new to adalimumab therapy.
• New Prior Authorization Requirements for Brand Humira: Members new to therapy must fail one of the two preferred biosimilars to access brand Humira through the prior authorization process.
• No Required Switch for Current Users: Members currently on Humira may remain on their therapy at least until mid-2025. They also have the option to switch to Simlandi (fully interchangeable with Humira) without a new prescription.
• Coverage Exclusions: All other adalimumab products will be excluded from coverage.
Biosimilars possess equivalent efficacy and safety profiles to their brand counterparts and help drive lower cost of care for both members and plan sponsors through additional market competition.

Clinical, Cost, and Member Access
Unlike some PBMs that prioritize their own, white-labeled biosimilar products through their own pharmacies, ClearScript offers more flexibility in product selection and fulfillment channels. By prioritizing biosimilars and Humira on the preferred tier, we ensure clinical needs guide choices—not cost alone. This approach preserves members’ therapy options without increasing out-of-pocket costs and reduces the likelihood of switching to other high-net-cost agents.

Ultimately, ClearScript fully expects our clients to realize cost savings as biosimilar products continue to expand in the marketplace. With a commitment to improving member health and managing costs, we will continue monitoring biosimilar market dynamics and adjust our formulary strategies as new, clinically sound, and cost-effective products emerge.