Supporting Stabilized Patients and Ensuring Continuity of Care

Employees who are already stabilized on Humira often face anxiety or resist when asked to switch medications.

With Humira's high cost — more than $8,000 per month, due to the complex biologic process used to make it — employers must find ways to manage costs without compromising patient care.

Related: How the biosimilar market really works

Establishing a medical exception process ensures that individuals with complex medical needs who require continued access to Humira can maintain their care without disruption.

For patients willing to transition to biosimilars, collaboration with health care providers is essential to develop personalized transition plans that prioritize patient well-being. Moreover, educating employees about the importance of continuity in managing autoimmune conditions can help ease concerns and build confidence in their treatment plans.

Incorporating Biosimilars Strategically

Biosimilars, FDA-approved alternatives to Humira, offer comparable safety and efficacy at a lower cost, making them a compelling option for health plans.

To maximize savings without compromising care quality, employers should consider including multiple biosimilar options in their plans. Offering two or more biosimilars fosters competition, improves accessibility and drives cost efficiency.

Additionally, employers can incentivize the adoption of biosimilars by reducing co-pays or waiving cost-sharing requirements, making these alternatives financially appealing to employees.

Partnering with pharmacy benefit managers to monitor clinical outcomes ensures that biosimilars deliver the same standards of safety and effectiveness as their branded counterpart.

Maximizing Plan Efficiency Through PBM Collaboration

PBMs play a pivotal role in optimizing pharmacy plans for cost-effectiveness and accessibility.

Employers can collaborate with PBMs to negotiate competitive rebates for both Humira and biosimilars, ensuring the best value for their plans.

Implementing step therapy protocols, which require patients to try biosimilars before approving Humira, can help prioritize cost-effective treatment options.

Additionally, tiered formularies that strategically structure medication options can encourage the use of biosimilars while maintaining employee choice, ensuring that plans remain both cost-efficient and flexible.

Addressing Employee Concerns During Transitions

Switching from a trusted medication like Humira to a biosimilar can be challenging for employees, making proactive communication and support critical.

Employers should provide clear, straightforward education about the safety and efficacy of biosimilars through accessible channels like webinars, newsletters and one-on-one consultations.

Highlighting financial support programs, such as co-pay assistance for biosimilars, can further alleviate employee concerns by showcasing tangible benefits.

To ensure a smooth transition, employers should work closely with health care providers to create personalized plans that minimize disruption and reinforce the continuity of care for all employees.

Promoting Adherence and Managing Side Effects

Ongoing care and employee engagement are essential in managing autoimmune conditions, especially during transitions to biosimilars.

Employers can support adherence by offering follow-up counseling to address employee concerns about new medications.

Access to peer support programs and health care professionals, such as nurses or pharmacists, can help employees manage potential side effects and stay on track with their treatment.

These efforts not only improve health outcomes but also foster trust in the employer's pharmacy benefits strategy.

Monitoring Outcomes and Refining Strategies

To ensure the success of plan adjustments, employers should use data insights to monitor key outcomes, such as medication adherence rates and employee satisfaction.

Tracking these metrics provides valuable feedback for assessing the effectiveness of biosimilar adoption and other plan features.

Based on real-world insights, employers can refine their formulary strategies, communication plans and support services, ensuring that their pharmacy benefits continue to meet employee needs while optimizing cost efficiency.

The Future of Smarter Coverage: Affordable Care, Sustainable Plans

Optimizing Humira coverage is not just about reducing costs—it's about delivering effective, compassionate care while ensuring plan sustainability.

By strategically integrating biosimilars, supporting stabilized patients and working closely with PBMs, employers can balance outcomes, access and affordability.

The result? A pharmacy benefits plan that empowers employees to manage their health confidently while controlling rising costs.

Cynthia Chioma Nwaubani, BCGP, is a doctor of pharmacy and the CEO and founder of PharmD Live.