Formularies to include biosimilar over brand Lantus®, saving millions of dollars for health plans and their members
Eagan, MN /PRNewswire/ - Prime Therapeutics LLC (Prime), a leading pharmacy benefit manager (PBM) serving nearly 33 million members, will be preferring Viatris' biosimilar Semglee® (insulin glargine-yfgn, the branded product) injection and Insulin Glargine (insulin glargine-yfgn, the unbranded product) injection, co-developed with Biocon Biologics, on its national formularies as part of the pharmacy benefit. This decision follows the U.S. Food and Drug Administration's (FDA) recent approval of the first interchangeable biosimilar insulin product through the interchangeable pathway. Semglee's interchangeable designation means there are no clinical differences between it and Lantus®, the originator brand product, and allows for substitution at the pharmacy which is dependent on state pharmacy laws.
Biosimilars, which are biologic drugs, treat conditions such as diabetes, multiple sclerosis, rheumatoid arthritis and cancer. Biologic drugs are large molecule drugs with complex mechanisms of action (living cells or complex proteins), and they are often genetically modified in some way. ¹ An FDA biosimilar approval means there is no clinically meaningful difference between a biosimilar and its biologic reference product. The biosimilar delivers the same quality, safety, purity, potency and effectiveness. ²
Biosimilars often have initial prices that are 15% to 35% lower than the reference products, which is particularly important as drug costs continue to increase, and specialty drugs now represent more than 50% of the health care dollar.
Preferring biosimilars across numerous treatment categories can save health plans and their members hundreds of millions of dollars. In particular, treatment costs in the diabetes population continues to rise, so having a biosimilar replace a brand product will yield significant savings.
"This formulary change reinforces Prime's commitment to increasing biosimilar adoption and also demonstrates that we are not beholden to rebates, as we're able to also prefer the lowest net cost therapy," noted Kelly Pokuta, vice president and chief trade relations officer at Prime. "We're at a pivotal moment in the U.S. drug landscape and this is a great win for payers and members."
"This is really great news for people living with diabetes as biosimilars can deliver savings for patients without sacrificing safety and efficacy," said Joseph Leach, MD, chief medical officer at Prime. "Payers and prescribers need to embrace these effective alternatives, just as they did years ago with generics, so we can help drive down rising health care costs for everyone."
Prime anticipates no significant member disruption and affordability will be comparable or better with the biosimilar. Prime's clients can choose its national formulary strategy for their commercial and Health Insurance Marketplace members beginning Jan. 1, 2022.
Earlier this year, Prime launched MedDrive™ medical drug management solutions, a new product which focuses on drug savings strategies through greater biosimilar drug adoption, most which are paid on the medical benefit. Other elements of MedDrive include benefit designs that prefer lowest net cost non-biosimilar drugs, plus enhancements to predictive data analytics, medical sourcing opportunities, and consultation services. For more on Prime's efforts around biosimilars:
1. What is a biosimilar? U.S. FDA. Accessed at: https://www.fda.gov/media/108905/download
2. Biosimilar Development, Review, and Approval, Oct 20, 2017. U.S. FDA. Accessed at: https://www.fda.gov/drugs/biosimilars/biosimilar-development-review-and-approval
About Prime Therapeutics
Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves nearly 33 million people. It is collectively owned by 19 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans. For more information visit www.primetherapeutics.com or follow @Prime_PBM on Twitter.