In our ongoing efforts to ensure access to high quality, affordable health care, Excellus BlueCross BlueShield leads the insurance industry in pursuing biosimilar drugs for our members. According to the FDA*, biosimilars are safe and effective treatment options for many illnesses and can often be provided at a lower cost. Excellus BCBS began the journey of biosimilar adoption in 2018 as the first stand-alone health plan to prefer a biosimilar in the Infliximab category.
Over the years, Excellus BCBS had educated countless stakeholders throughout the country on how to implement a successful biosimilar program. We’ll now use our expertise to continue to provide member-centric care and maximize savings opportunities for our community by preferring two biosimilars, along with HUMIRA®, for all our custom formularies.
Effective September 1, 2023, Excellus BCBS will offer:
- Boehringer Ingelheim’s CYLTEZO®, which is available in low concentration, and
- Organon’s HADLIMA™, available in high and low concentrations.
With eight manufacturers currently making eleven options in the Humira category (and more to come), our preferred biosimilars were chosen after an extensive clinical review. We believe 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 members.
Read our press release to learn more and share this exciting information with your groups today.
Excellus BCBS Biosimilars Press Release
