Excerpt: “Humira, a biologic drug used to treat autoimmune conditions such as rheumatoid arthritis, is one of the best‑selling prescription drugs in the world. In the United States, it has an annual list price of approximately $90,000. In 2022, it cost the Part D program and enrollees $5.4 billion before accounting for rebates and other price concessions. The launch of Humira biosimilars (which are highly similar to Humira, with no clinically meaningful differences) has been anticipated as an opportunity to lower biologic drug costs through competition. However, if Part D plans’ formularies restrict access to Humira biosimilars, competitive pressure—and its potential effects on lowering drug costs—may be limited. Previous OIG work found that many Part D formularies did not cover biosimilars available for other expensive biologic drugs. OIG also found that this lack of formulary coverage could limit wider biosimilar use and any potential savings for Medicare Part D. … Nearly all Part D Prescription Drug Plans (PDPs) (96 percent), and 88 percent of Medicare Advantage Prescription Drug (MAPD) plans, covered at least 1 of the 10 available Humira biosimilars on their 2025 formulary—including some plans that covered Humira biosimilars only and not Humira. This represents substantial growth in formulary coverage from 2024, when only 65 percent of PDPs and 52 percent of MAPD plans covered at least one of Humira’s biosimilars.”
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