Top PBM Optum Rx may be moving into the biosimilar business, joining its competitors CVS and Express Scripts, according to a US trademark application for a business called Nuvaila.
The application to the US Patent and Trademark Office was submitted on June 4 by Optum Health Solutions, an Optum Rx subsidiary. The Nuvaila application says it is for “procuring biosimilar pharmaceuticals and selling pharmaceuticals to wholesale pharmaceutical distributors.”
A representative for UnitedHealth Group, which owns Optum Rx, declined to comment.
Such a move would follow in its competitors’ footsteps, although each of the top three PBMs is attacking biosimilars differently.
CVS created a subsidiary to partner with the generics giant Sandoz to sell the Humira biosimilar Hyrimoz. On April 1, CVS removed brand-name Humira and started exclusively covering Hyrimoz, leading to an “explosion” of Hyrimoz scripts, analysts wrote at the time.
A representative for CVS told Endpoints News that the company is “absolutely” planning on expanding its coverage to other drugs, adding that “it’s been a long time coming in terms of unlocking the biosimilar market in the United States.”
In April and May, 97% of eligible patients have transitioned to one of the biosimilars instead of brand-name Humira, the CVS representative said, resulting in a savings of $315 million.
“Once we had the confidence that there was going to be a strong supply of this biosimilar product and that there wouldn’t be a shortage then we made the move to exclude Humira from our formulary,” the CVS representative said.
Cigna’s health services arm Evernorth also said that it plans to offer a cheaper copycat of Humira for $0, although there have been no changes to Cigna PBM Express Scripts’ coverage of Humira on its standard formularies.
The situation shows how more market entrants does not necessarily mean more savings.
Nicole RapfogelNicole Rapfogel, a policy analyst for health at the Center for American Progress, said that bringing more biosimilars into the market typically brings down prices overall, but it’s still “another mega-entity entering into the space, where we already know the smaller players are losing out and that the more layers of profit we add to something, especially for these mega-entities, the more money that’s going to profit that could go to patients’ pockets.”
Ge Bai, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, told Endpoints that now that major PBMs have entered the market, competition will bring pricing pressure to manufacturers.
“Biosimilar manufacturers will have a harder time gaining market share when competing with the gatekeeper’s own products,” Bai said. “As a result, they will seek alternative options to reach patients without going through insurance/PBMs. This is similar to what is happening in the generic drug market.”