Blue Shield of California lowers costs of world's best-selling drug

OAKLAND, Calif., Oct 1, 2024 /PRNewswire/ – Blue Shield by California announced today that it has dramatically reduced the price it will pay for an FDA-approved biosimilar of the blockbuster drug Humira – by purchasing the drug at a transparent net price of $525 per monthly dose compared to Market reported net price of Humira at $2,100.

The innovative agreement with drugmaker Fresenius Kabi, an operating company of Fresenius, and Evio Pharmacy Solutions that made the deal possible eliminates the excessive markups often found in a traditional pharmacy benefit manager model. Instead, Blue Shield's new Pharmacy Care Reimagined model — among several other innovations — allows the nonprofit health plan to provide its members with greater access to biosimilar medications. Biosimilar drugs are approved by the FDA because they offer patients the same clinical effectiveness as a brand-name version – at a significantly lower, transparent cost.

“We will no longer participate in a pharmacy system designed to maximize participant profits rather than quality, convenience and cost-effectiveness for consumers,” he said Paul MarkowitschCEO, Blue Shield of California. “Every employer, health plan and payer should require – and challenge – their pharmacy benefit managers to offer clinically effective and lower cost alternatives at a transparent price. That’s why Blue Shield decided to rebuild our pharmacy delivery system – so we can get medicine to the right people, at the right time, at the right price.”

The collaboration via Blue Shield from CaliforniaFresenius Kabi and Evio Pharmacy Solutions marks the first time this unique business model has been used to bring a Humira biosimilar to market. Aligning incentives and removing excessive complexity between the three stakeholders unlocked the value of Fresenius Kabi's Humira biosimilar adalimumab-aacf in a system where adoption of these lower-cost alternatives was limited due to supply chain barriers.

Starts on January 1, 2025Most commercial Blue Shield members who use Fresenius Kabi's Adalimumab-aacf pay $0 out of your own pocket. Through this collaboration, drug spending is expected to decrease while adherence is expected to increase, positively impacting the overall cost of care and, more importantly, members' health outcomes.

“Biosimilars are safe, effective and essential to reducing the cost of biologic medicines and improving their access to patients.” the United States” said Pierluigi AntonelliPresident and CEO of Fresenius Kabi. “Fresenius Kabi is pleased to be able to offer this option to Blue Shield of California and their members. Our shared goal is to make medicines more affordable and accessible by simplifying the medicine's journey to patients. This allows savings to be prioritized through lower overall net costs, which can improve both premiums and patient out-of-pocket spending on their medications.”

Evio Pharmacy Solutions facilitated the agreement, which emphasizes low net costs and eliminates the traditional incentives for pharmacy benefit managers that encourage higher list prices, resulting in high net costs and higher profits for intermediaries. Given the looming “biosimilar cliff” of several lower-cost biosimilar drugs about to enter the market, this move toward transparent net pricing sets an important precedent and path forward for the rest of the market.

“We are excited to continue our pharmacy transformation journey with Blue Shield Californiaas our first health insurance customer to participate in this new net pricing model,” said Matt SeibtHead of Pharma Partnerships at Evio Pharmacy Solutions. “This offering will have a huge impact on reducing healthcare costs. Evio will continue to leverage our innovative contracting and operating model to create additional biosimilar opportunities over the next few years.”

The drug

Since being approved by the Federal Drug Administration in 2002, Humira has become a household name. And although the drug has helped many patients in treating inflammatory diseases such as arthritis, Crohn's disease, ulcerative colitis, psoriasis, etc., it has become one of the most glaring examples of overpricing and patent abuse in the pharmacy supply chain.

For over 20 years, the drug has been widely used by more than 300,000 Americans each year. After two decades of market exclusivity and $200 With sales of $1 billion billion, Humira's patent exclusivity expired in the year January 2023This makes cheaper alternatives – so-called biosimilars – available. However, the price has not fallen to the extent required in a functioning market, limiting widespread adoption.

Blue Shield spends more on Humira than any other drug for its members, processing about 40,000 Humira prescriptions annually. Therefore, an alternative option that is transparently priced, sustainably affordable, and clinically effective is needed to alleviate rapidly rising healthcare costs.

“Humira has come under fire from both consumers and policymakers for its high and inconsistent pricing,” he said Matt GibbsVice President of Pharmacy Transformation at Blue Shield of California. “With our new low-cost alternative, Blue Shield offers members and employers a more affordable, yet equally clinically effective option. This move continues our organization’s journey to create transparency and transform pharmacy care for the better.”

Last year, Blue Shield announced its “Pharmacy Care Reimagined” initiative – a first-of-its-kind initiative that unbundles the opaque medication care model of the traditional pharmacy benefit manager, bringing transparency to every part of the system. Today's biosimilar expansion is the latest example of this Transformation work and the nonprofit health plan's efforts to reform the drug delivery ecosystem. It also marks Blue Shield's continued collaboration with Evio Pharmacy Solutions as part of the health plan's broader initiative to ensure its members receive easier, more affordable access to quality medications.

About Blue Shield by California

Blue shield from California strives to create a healthcare system that is worthy and sustainably affordable for his family and friends. The health plan is a tax-paying, not-for-profit, independent member of the Blue Shield Association with more than 4.8 million members, over 7,100 employees and more 25 billion dollars in annual sales. Founded in 1939 San Francisco and is now headquartered in OaklandBlue shield from California and its subsidiaries provide health, dental, vision, Medicaid and Medicare health care plans California. The company has more than contributed 77 million dollars donated to the Blue Shield of California Foundation for the last three years to make an impact California communities.

More Blue Shield news from Californiaplease visit news.blueshieldca.com.

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SOURCE Blue Shield by California