Easier access to biosimilar medications improves affordability for CU health plan members

The CU Health Plan team remains committed to equipping plan members and their families with the information needed to make informed choices regarding their health care.

Effective April 1, Humira will be removed from the Anthem Exclusive, Extended, High-Deductible, and Medicare plan formularies, and Humira biosimilar (adalimumab-adaz ; brand name Hyrimoz) will be covered for members of these CU health plans. This biosimilar offers the same clinical effectiveness as the brand-name product, Humira, and offers savings potential for CU health plans, with a list price more than 80% lower than the current list price of Humira.

Just as generic medications transformed the pharmaceutical landscape, biosimilars have the power to do the same for biologic medications. Together with CVS Caremark, the CU Health Plan is eager to promote access to more affordable medications that offer the same clinical effectiveness for CU health plan members through the availability of biosimilar medications. Members of Anthem-administered CU health plans (Exclusive, Extended, High-Deductible, and Medicare) whose pharmacy benefits are provided through CVS Caremark are encouraged to learn more about the advantages of biosimilar medications when biosimilar alternatives to a member’s medication(s) are available.

The CU Health Plan spoke with Gina Moore, PharmD, MBA, associate dean and associate professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the CU Anschutz Medical Campus, to learn more about biosimilars and the benefits they pose to CU health plan members.

What are biosimilars? Biosimilars are safe and effective biologic medications for treating many illnesses such as chronic skin and bowel diseases, arthritis, kidney conditions, macular degeneration, multiple sclerosis, and some cancers (such as breast, lung and colon).

“Biosimilars are FDA-approved alternative medications that are compared to another medication – the original biologic, also known as the reference product,” Moore said. “Since biosimilars are made with the same types of natural sources as the reference product they are compared to, they provide the same treatment benefits with no clinically meaningful difference from the reference product.”

This means you can expect the same safety and effectiveness from the biosimilar over the course of treatment as you would the reference product.

A biosimilar is very similar, but not identical, to an original biologic medication.

For biosimilars to be approved by the FDA, studies must show that there are no differences in the safety and effectiveness of biosimilars and the original biologics.

Both a biosimilar and its original biologic:

• Are made from the same types of sources (e.g., living sources).
• Provide the same benefits when treating diseases or medical conditions.
• Are given at the same strength and dosage.
• Are not expected to cause new or worsening side effects.

Are biosimilars like generic medications?

Biosimilars are like generics in some ways, in that both types of medications are compared to a reference (original) product for approval, and both biosimilar and generics go through a rigorous review process. Once FDA-approved, these medications are just as safe and effective as the reference products they are compared to.

Like generic drugs, biosimilars can help lower drug costs for CU health plan members. Someone might switch to a biosimilar because of a change in insurance coverage or to save money. The lower cost is not a reflection of effectiveness or safety of biosimilars. Because of the lower cost, biosimilars may be covered by more insurance companies and offer patients additional treatment options.

So, how are biosimilars different from generics?

“Biosimilars differ from generics in a few key ways,” Moore said. “At the most basic level, generics are identical to their reference drugs, whereas biosimilars are considered substantially similar to theirs. This is because generics are made from chemical ingredients, while biosimilars are generally made from natural and living ingredients.”

In contrast to a chemical, which is synthesized and is generally copied, a biologic medication is made from natural and living sources and cannot be exactly copied. So the information needed to demonstrate that a biologic is biosimilar to another biologic is much more extensive than what is needed for a generic.

“Because most biologics are made from living sources, it is normal for both biosimilars and original biologics to have minor differences between batches of the same medication,” Moore said.

The ingredients used in biologics cannot be copied exactly, which is why biosimilars are not identical to the original biologic in the same way generic drugs are an exact chemical copy as their brand-name alternative. The FDA carefully reviews the differences between the original biologic and the biosimilar to ensure that biosimilars are as safe and effective as the original biologics.

What is an example of a medication and a biosimilar alternative? Humira is a common prescription medicine used to treat moderate to severe rheumatoid arthritis (RA) in adults.

Effective April 1, Humira will no longer be covered for members of the Exclusive, Extended, and High Deductible CU Health Plans. Adalimumab-adaz (Hyrimoz) is a biosimilar of Humira and is covered under these health plans if you and your prescriber decide continuing adalimumab therapy is right for you. Switching to adalimumab-adaz (Hyrimoz) offers savings potential for the CU health plans because the list price of this medication is substantially lower than the current list price of Humira.

For clinical questions, CU health plan members taking Humira should speak directly with their provider or pharmacist about biosimilar options. For questions regarding coverage, members can reach out to the dedicated CVS Caremark member services line at 1-888-964-0121, available 24 hours a day, 7 days a week, 365 days a year.

The CU Health Plan team continues to find innovative ways to help plans lower total costs while maintaining clinically appropriate coverage for all plan members. As costs fluctuate with the dynamic health care landscape, CU Health Plan members may find switching to biosimilar alternatives of their medications an easy and effective way to help mitigate their family’s health care spending. Members are encouraged to talk with their providers about biosimilar treatment options and any clinical questions they may have about making the switch. For questions regarding insurance coverage, contact the CVS Caremark dedicated member services line at 1-888-964-0121.