Biosimilars represent one of the biggest opportunities to improve access and affordability for our community. Excellus BlueCross BlueShield (Excellus BCBS) has advocated for the use of biosimilars since 2018 when we were the first standalone health plan to prefer a biosimilar in a major drug category. Today we include biosimilars in all 10 drug categories in which biosimilars are available.
Humira™ (adalimumab) is the top-selling pharmaceutical in the world, indicated for many autoimmune, rheumatologic, and gastrointestinal diseases. The first Humira biosimilar launched in 2023. Now, 18 Humira biosimilar versions are approved in the US.
Excellus BCBS offers multiple formulary options for our large employer groups, dependent on the funding agreement. In 2024 Excellus BCBS commercial formularies preferred biosimilars Cyltezo® and Hadlima along with the reference drug Humira.
For 2025:
- The low wholesale acquisition cost (WAC) biosimilar Simlandi® has been added as a preferred biosimilar. Simlandi is an interchangeable biosimilar which means pharmacies can dispense Simlandi instead of Humira without prior physician approval.
- Hadlima will remain preferred; it is available in both high and low concentrations and has a low wholesale acquisition cost.
- Humira will remain preferred.
- Cyltezo will no longer be preferred.
Due to natural conversion over to the interchangeable biosimilar, Simlandi, and the competitive contracting on Humira, Excellus BCBS believes that retaining Humira on the formularies maintains member stability.
This strategy applies to 3 Tier Open, Preferred Value Formulary and Exchanged Closed Formulary. All three drugs Humira, Hadlima, and Simlandi will be Tier 2 in 2025.
Through our partnership with Express Scripts (ESI), we also offer the National Preferred Formulary (NPF) to our self-funded employer groups:
- Effective January 1, 2025, Humira will be excluded for new members.
- Effective July 1, 2025, Humira will be excluded for all members.
- The NPF has both high and low WAC biosimilars as preferred. They include Adalimumab-adaz by Sandoz, Adalimumab-adbm by Quallent, Adalimumab-ryvk by Quallent, Cyltezo, and Simlandi.
Our clients will continue to see savings from the increase in competition the biosimilars have brought for whichever formulary is chosen.
Biosimilars are safe, effective, Food and Drug Administration (FDA) approved medications. Adding biosimilars to the list of medications covered by our health plan gives members who need these types of medications a choice, increasing our communities’ access to the affordable medications.
To learn more about biosimilars see Preparing for the Biosimilar Landscape - Excellus for Business.
Read Our Blog - Preparing for the Biosimilar Landscape
