Cigna to Remove AbbVie’s Humira from Drug Reimbursement Lists in 2025

The decision will affect plans managed by Express Scripts, the pharmacy benefits unit of Cigna. 

US-based Cigna has announced that starting in 2025, it will no longer include AbbVie’s Humira on some of its preferred drug reimbursement lists. 

Reportedly, the decision will affect plans managed by Express Scripts, Cigna's pharmacy benefits unit. 

Instead, the company will recommend biosimilar alternatives to the popular rheumatoid arthritis drug, which has been a leading medication in the market for years.

Cigna’s Sudden Shift

Cigna plans to cover several biosimilar versions of Humira, including Boehringer Ingelheim’s Cyltezo, Simlandi from Teva and Alvotech, and an unbranded version of Hyrimoz from Sandoz, on certain reimbursement lists. 

This move comes after a similar decision by CVS Health’s Caremark unit earlier in the year. 

In April, Caremark removed Humira from its list of recommended drugs, leading to a significant shift in the market. More patients transitioned to biosimilar versions of Humira in just three weeks than in the prior 15 months combined.

Express Scripts is joining this trend, becoming the second major US pharmacy benefits manager to stop recommending coverage of Humira. 

This development puts additional pressure on AbbVie, the dominant force in the market for rheumatoid arthritis treatments. 

The company has not commented on Cigna's decision but has acknowledged that it expects to maintain a smaller market share for Humira in the coming year.

Scrutiny of Pharmacy Benefit Managers

This year, US agencies and lawmakers have been increasingly scrutinizing the role of pharmacy benefit managers (PBMs) such as Express Scripts and Caremark. 

Critics argue that these middlemen play a significant part in keeping drug prices high despite their claims of helping to lower costs for consumers. PBMs negotiate volume discounts and fees with drug companies and manage the lists of drugs covered by insurance plans.

Despite the launch of 10 Humira biosimilars in the US in January 2023 from companies such as Amgen and Pfizer, AbbVie has retained a significant portion of the market. 

The company has achieved this by negotiating favorable positions on insurance drug coverage lists, a strategy that may now face challenges as more PBMs shift towards covering biosimilars instead.

Humira, which reached peak sales of $21.2 billion in 2022, has long been one of the world’s top-selling prescription medicines. However, the market dynamics are changing with the growing availability of biosimilars. 

In June, Cigna had already taken steps to make Humira biosimilars available with no out-of-pocket costs for eligible US patients using its specialty pharmacy. However, this did not significantly impact AbbVie's market share.

Future Market Dynamics

As the market adjusts to the increasing adoption of biosimilars, AbbVie may face further challenges in retaining its position. Express Scripts and UnitedHealth Group's Optum Rx, two of the largest PBMs, had opted to keep Humira on their reimbursement lists for 2023 and 2024. 

However, Caremark's recent moves and Express Scripts' now suggest a shift in strategy among major PBMs, which could accelerate the transition away from Humira to lower-cost alternatives.

Optum Rx did not immediately respond to requests for comment on whether it would follow suit in removing Humira from its reimbursement lists next year. 

The continued evolution of the PBM landscape and the response from major players such as AbbVie will likely shape the future of the rheumatoid arthritis drug market in the US.

As healthcare providers and patients navigate these changes, the broader implications of PBM decisions will remain a critical area of focus, particularly as scrutiny from regulators and lawmakers intensifies. 

The coming year could see further developments in the competitive dynamics surrounding Humira and its biosimilar alternatives.