Millions of arthritis patients could struggle to get blockbuster drug, as CVS pulls it from pharmacies

CVS is set to become one of the first major pharmacy to remove the blockbuster arthritis drug Humira from some of its shelves in a move that could save customers money.

In a release today, the chain — with 9,500 stores nationwide — said the drug would be removed from its preferred list for reimbursement beginning April 1.

The medication, which costs $6,922 per month in direct costs, will be replaced with the biosimilar drug Hyrimoz, costing $6,575, and an unbranded version, which costs $1,315.

The pharmacy chain is also working on its own co-branded version of the drug which AbbVie, the maker of Humira, which will be available later this year.

Humira — which contains the active drug adalimumab — is used to treat the autoimmune condition rheumatoid arthritis and has a 20-year patent, allowing AbbVie to make more than $200billion off the medication.

Humira has held a monopoly in the market for 20 years, making its owner AbbVie more than $200billion. CVS is the first major chain to announce it is switching to an alternative

The chain – with 9,500 stores nationwide – said the shift was aimed at saving customers money

President of the CVS Caremark pharmacy benefit division, David Joyner, said: ‘By preferring biosimilars that have a significantly lower list price than their reference product, CVS Caremark is putting our customers in the driver’s seat to best meet the healthcare needs of their members and lower drug costs.’

A CVS spokesperson told Reuters the company expects most of its customers to transition their treatment once the original drug is taken off shelves.

A biosimilar refers to a copy of a complex biotech drug, like adalimumab, which is made by living cells and is unable to be identically replicated.

CVS said Humira would still be available at its stores under certain insurance plans.

Humira was once the world’s biggest selling prescription medicine, with peak sales of $21.2billion in 2022.

AbbVie managed to extend its monopoly, meant to expire in 2016, through January 2023 — allowing them to block alternatives while hiking prices.

But as alternatives become more readily available, customers and pharmacy chains are now able to sell cheaper versions of the drug.

Adalimumab is an immunosuppressive drug used to treat many inflammatory conditions in adults, such as rheumatoid arthritis, psoriatic arthritis and plaque psoriasis, among other conditions. 

More than 11 million Americans suffer from these conditions, estimates suggest, with about 313,000 having symptoms serious enough to be prescribed Humira. 

The medication is administered as an injection every other week into the front of the thighs or lower abdomen.

It works by stopping the protein TNF from binding to and attacking healthy cells, which can cause inflammation and the pain associated with rheumatoid arthritis.

Swiss drugmaker Sandoz is supplying the unbranded version of Humira for CVS as well as Indian pharmaceutical company Biocon.

Although nine Humira biosimilars were launched the US last year from drugmakers including Amgen, Pfizer and Boehringer Ingelheim, AbbVie has managed to retain most of the market by negotiating favorable positions on insurance drug coverage lists.

According to data from the marketing company IQVIA, an average of nearly 76,000 Humira prescriptions were written per week in the second half of last year. The closest competitor, Amgen, averaged 417 prescriptions per week for its biosimilar Amjevita.

This most recent announcement comes after CVS said people filling prescriptions at pharmacy locations may soon pay less for their drugs as it overhauls its business model.

Currently, what customers pay for drugs and how much the pharmacy receives is determined by middlemen called pharmacy benefit managers, which negotiate reimbursement from drug makers to insurers.

The complex reimbursement formula is not directly based on what pharmacies pay for specific drugs.

With the existing model, pharmacies may get paid at higher rates for certain medications, with that margin being used to subsidize losses on other prescriptions.

Under the new plan, CVS’ pharmacies will get reimbursed based on the amount that CVS paid for the medication, as well as a fixed markup and flat fee to cover the services involved in handling and dispensing the prescription.

Humira is not the only drug seeing a generic overhaul under its new business model. 

Millions of Americans could soon be forced to live without life-saving medication after pharmaceutical giant GSK announced it would pull an asthma medication from its stores. 

Flovent, the most commonly prescribed inhaler for people with asthma, is no longer available in pharmacies as of January 1.

The drug’s manufacturer, GSK, announced it was discontinuing its branded inhaler and making an ‘authorized generic’ version.

The generic medication will be an identical version to the branded Flovent, which is taken daily to help prevent asthmatic symptoms, GSK said.