Oct 28, 2024
A new biosimilar for Humira, the world’s best-selling drug, will be available at $0 co-pay for most members starting 1/1/2025 with the launch of Blue Shield’s Pharmacy Care Reimagined model for commercial customers. Blue Shield collaborated with Fresenius Kabi and Evio Pharmacy Solutions to purchase FDA-approved Humira biosimilar for $525 per monthly dose, compared to the market reported net price of Humira at $2,100.
This collaboration will bring drug spending down while adherence for the medication is expected to go up, benefiting the overall cost of care and, more importantly, member health outcomes. Read the full announcement here and visit the dedicated Pharmacy Care Reimagined page here.
Blue Shield members with existing prescriptions for Humira will be encouraged to switch to the biosimilar. However, if their provider continues to prescribe the brand name drug it will be covered according to the member’s plan benefit with applicable copays.
Any new prescriptions for brand name Humira on or after January 1, 2025, will require a medical exemption approval submitted by the provider. If the prescription is not approved through this process the member will be responsible for the full price of the drug.
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