Biosimilars Present an Exciting Opportunity for Cigna’s Evernorth, Says CEO Palmer

For years, biosimilars have been on the horizon, but finally the horizon is getting close, said Eric Palmer, president and CEO for Evernorth, a Cigna company, at a health care conference hosted by a financial services company.

Palmer discussed the financial health and growth expectations of Evernorth, which Cigna launched in 2020. Evernorth includes pharmacy benefit manager Express Scripts, specialty pharmacy Accredo, and utilization management service eviCore.

He also noted that, in 2022, Evernorth is responding to 3 things changing health care right now: pharmacological innovation, the link between mental and physical health, and the movement toward care being delivered in different locations, specifically the home and in a virtual setting.

Biosimilars, according to Palmer, “present a really exciting opportunity” for Evernorth to bring together its clinical, specialty pharmacy, and supply chain expertise. In addition, the increased competition that biosimilars will bring to the marketplace is exciting and can mean better outcomes for health plans, employers, and patients. “That’s really valuable,” he said.

In 2023, Humira, which has generated a lot of rebates in the system, will face biosimilar competition for the first time since the FDA approved the first Humira biosimilar, Amjevita from Amgen, in September 2016. Amjevita is expected to launch in the United States in January 2023 as a result of an agreement that Amgen entered with AbbVie, the maker of Humira.

There are 7 FDA-approved adalimumab biosimilars, the most recent of which was Yusimry, approved December 2021. None of them have launched in the United States due to agreements with AbbVie. However, all of them are expected to launch in 2023. Among the 7 is Cyltezo from Boehringer Ingelheim, which is actually the only interchangeable adalimumab biosimilar. Cyltezo is expected to launch July 1, 2023.

The interchangeability status of Cyltezo could be important. Until now, the cost discount of biosimilars has been less like generics and more like slightly less expensive branded drugs in the United States. Having an interchangeable could result in a larger drop in costs.

A paper published online early in The American Journal of Managed Care^® speculated, “Interchangeable biosimilars may be perceived as closer substitutes to reference biologics, and as a result, they may achieve larger market shares and yield steeper price reductions…”

Palmer addressed the loss of rebates that will occur when people switch from the branded drug to the adalimumab biosimilars and noted it will depend on the types of arrangements they have with clients, such as full pass-through rebate arrangements, dollar amount guarantees, or something else.

“…we’ll do better when we can deliver lower cost to our clients whether that shows up in the form of additional rebate dollars or in the form of fees that we can earn or in the form of us more effectively managing total cost guarantees,” Palmer said. “Those are all things that will be of value to us and things we’ll work through.”

He did note that going from a branded drug to the biosimilar is going to be more difficult than going to a small molecule generic, but he’s confident that Evernorth is already well positioned in this area to drive the transition. He pointed to the scale of expertise and relationships with pharmacists and prescribers to drive engagement and communication.

“I think we have all of the needed elements to really maximize the opportunities [with biosimilars] and we’re excited about that,” he said.

Evernorth expects to see biosimilars in the United States continue to grow in the next decade, with more getting produced, approved, and launched. There are more than 70 biosimilars for 24 reference drugs in the pipeline, wrote Urvashi Patel, PhD, managing director, Evernorth Research Institute, in June 2021.

“The patents for 17 major biologics are set to expire over the next decade, opening the door for increased biosimilar competition,” she wrote. “A recent Evernorth analysis estimates that this biosimilar competition can save the US $225 billion to $375 billion in pharmacy spend by the year 2031.”