Credit: J.B. Reed/Bloomberg
It's official! UnitedHealth's Optum Rx pharmacy benefit manager unit will not be a haven for employers and workers who love Humira.
The PBM told sponsors of commercial plans in August that it plans to move away from use of AbbVie's popular immune system control drug starting Jan. 1, 2025.
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Patients who are already taking Humira can still take it, but Optum Rx will exclude Humira coverage for patients new to the drug and encourage those patients' doctors to prescribe Amgen's Amjevita, according to the August notice.
The Optum Rx business committee made the decision about Humira based on recommendations from an Optum Rx committee made up of independent physicians and pharmacists, Optum said.
"We have chosen to wait on preferring only Humira biosimilars until all drug strengths are interchangeable at the pharmacy without a new prescription, which is expected later in 2025," Optum added.
Humira is a human monoclonal antibody. It's a "biologic" drug, meaning that it's made from living cells, not simply produced by mixing ordinary chemicals together.
The history
AbbVie had a patent on the drug until early 2023, and it had a suggested retail price of $7,000.
In 2023, for example, Humira was so expensive and so popular that it cost U.S. employers more than any other drug, according to Milliman. The firm's analysts estimated Humira prescriptions accounted for about $145 in U.S. employer spending per plan enrollee.
CVS Health announced a shift away from Humira in August, and Cigna's Express Scripts unit followed suit about a week later.
The future
Humira may soon be so unfashionable it becomes cool again.
Like Humira, the biosimilars that compete with Humira are expensive to make.
Humira is now cheaper in some cases than the relatively biosimilar rivals. At press time, two-syringe cartons of Humira were available on GoodRx for $550, with restrictions.
Some patients may be able to use a manufacturers' coupon to get Amjevita for a heavily discounted price, or even for free. But, for patients paying ordinary commercial prices, the cheapest carton of Amjevita syringes available on GoodRx was selling for $3,144.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
