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The ERISA Industry Committee — a group for employers with large, self-insured benefit plans — says many of its members are questioning how their pharmacy benefit managers are handling expensive "biologic" drugs like Humira.
PBMs often get paid based on the size of the rebates and drug discounts they negotiate for employers.
Even now, in spite of all of the members of Congress and state legislatures attacking rebate-based compensation, some PBMs still seem to be trying to maximize rebate-linked revenue by promoting Humira and other high-cost biologics, rather than encouraging patients to use much less expensive "biosimilars," or generic versions of the biologics, ERIC says in a new report.
Some ERIC members are still trying to understand what to do about biosimilars, ERIC says.
Some ERIC members are splitting with their PBMs over biosimilars and making separate biosimilar purchasing deals directly with the manufacturers.
ERIC is encouraging other members to cons ider making their own deals with biosimilar manufacturers.
"These actions can save employer plan-sponsors millions of dollars," ERIC says.
The backdrop: A biologic drug is a medication produced by living organisms, rather than a relatively simple chemical compound created using ordinary chemical processes.
Humira is a "tumor necrosis factor" blocker. It can protect patients against life-destroying, potentially deadly conditions such as rheumatoid arthritis and Crohn's disease.
In 2023, one carton containing two Humira injector pens cost about $7,300. Milliman reported that the drug was the most expensive for a typical U.S. employer-sponsored health plan and was costing employer plans about $145 per plan participant per year.
Some of Humira's biosimilars now cost less than $700 per carton.
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