Blue Shield California Offers Adalimumab Biosimilar for a Quarter of Reference Price

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Blue Shield California has reached a deal with adalimumab biosimilar manufacturer Fresenius Kabi to offer the drug at a quarter of the price of the market reported net price of reference adalimumab (Humira).¹

“We will no longer take part in a pharmacy system that is designed to maximize the profit of participants instead of the quality, convenience and cost-effectiveness for consumers,” Paul Markovich, CEO, Blue Shield of California, said in a statement.¹ “Every employer, health plan and payer should be asking — and challenging — their pharmacy benefit managers to offer clinically effective and lower cost alternatives at a transparent price. This is why Blue Shield decided to rebuild our pharmacy care system — so we can get medications to the right people, at the right time, at the right price.”

The agreement was reached between Fresenius Kabi, which manufactures adalimumab-aacf (Idacio) and is an operating company of Fresenius, and was facilitated by Evio Pharmacy Solutions. As part of the agreement, Blue Shield California will offer the biosimilar for $525 net price per monthly dose, compared to the market reported net price of Humira at $2,100. In a statement, Blue Shield California said that the deal was enabled by Blue Shield’s new Pharmacy Care Reimagined model and other innovations. The discount was enabled by eliminating supply chain obstacles and removes excess complexities. One of these "complexities" is the role of pharmacy benefit managers, which are sidestepped in the new agreement.¹

“Biosimilars are safe, effective and essential to lower the cost of biologic medicines and improve their access to patients in the United States,” Pierluigi Antonelli, president and CEO, Fresenius Kabi, added.¹ “Fresenius Kabi is pleased to provide this option to Blue Shield of California and their members. By simplifying the drug’s path to patients, our collective goal is to make medicine more affordable and more accessible. This allows for prioritizing savings through overall lower net costs that can improve both premiums and patient out-of-pocket spending for their medication.”

The agreement will go into effect on January 1, 2025, on which date most Blue Shield commercial members using adalimumab-aacf will pay $0 out of pocket. The company believes that not only will the collaboration bring drug spend down, medication adherence is also expected to go up, yielding reductions in overall cost of care and benefitting member health outcomes.¹

“We are excited to continue the pharmacy transformation journey with Blue Shield of California, as our first health plan customer to participate in this new net price model,” Matt Seibt, head of pharmaceutical partnerships at Evio Pharmacy Solutions, added.¹ “This offering will have a massive impact on reducing health care costs. Evio will continue to utilize our innovative contracting and operational model to craft additional biosimilar opportunities in the next few years.”

Other recent research into adalimumab biosimilars found that patients with inflammatory bowel disease (IBD) are satisfied with all adalimumab biosimilar and reference treatments, with some levels of variance. Patients using the subcutaneous injection form had the highest satisfaction with Yuflyma® (9.0; SD, 1.4), Humira (8.9; SD, 1.3) and Hulio (8.9; SD, 1.7; P <.05). Around one-third (n = 299; 31.8%) of all participants had injection site reactions. Over one-fifth of patients (n = 223; 23.7%) were previously treated with another adalimumab of which 32 (14.3%) discontinued treatment due to adverse events.²

“Humira has drawn scrutiny for its high and inconsistent pricing from both consumers and policymakers,” Matt Gibbs, vice president of pharmacy transformation at Blue Shield of California added.¹ “With our new low-cost alternative, Blue Shield offers a more affordable, yet equally clinically effective option to members and employers. This move continues our organization’s path of transparency and transforming pharmacy care for the better.”

REFERENCES

1. Blue Shield of California Slashes Cost of World’s Best-Selling Drug. News release. Blue Shield California. October 1, 2024. https://news.blueshieldca.com/2024/10/01/blue-shield-of-california-slashes-cost-of-worlds-best-selling-drug

2. Caron B, Seksik P, Buisson A, et al. Patient preferences for adalimumab in inflammatory bowel disease: a nationwide study from the GETAID. Therap Adv Gastroenterol. 2024;17. doi:10.1177/17562848241265776