CVS Health Drops J&J's Stelara from Main Formularies in Favor of Lower-Cost Biosimilars
Key Insights
CVS Health announced it will transition from Johnson & Johnson's psoriasis (search) drug Stelara to lower-cost biosimilar alternatives starting July 1, 2024.
The pharmacy benefit manager Caremark (search) will prefer biosimilar versions including Sandoz's Pyzchiva and Biocon Biologics (search)' Yesintek, with most members paying $0 out-of-pocket.
This formulary change represents CVS's broader strategy to expand biosimilar coverage across specialty categories including multiple sclerosis (search) and rare blood disorders (search).
CVS Health announced Tuesday it will remove Johnson & Johnson's psoriasis (search) drug Stelara from its main formularies starting July 1, opting instead for lower-cost biosimilar alternatives in a move that could significantly impact patient access and healthcare costs.
The company's pharmacy benefit management unit, Caremark (search), will transition to biosimilar versions of Stelara, specifically Sandoz's Pyzchiva and Biocon Biologics (search)' Yesintek. Under the new formulary structure, most members will pay $0 out-of-pocket for their therapy, potentially improving patient affordability while reducing overall healthcare expenditures.
Strategic Shift Toward Biosimilar Adoption
"Expanding adoption of FDA-approved biosimilars allows us to deliver significant savings for clients while supporting broader, more affordable access to proven therapies," said Joshua Fredell, senior vice president at CVS Health.
This formulary change reflects the growing acceptance of biosimilar medications in the U.S. healthcare system. Unlike generic versions of traditional pills that can be exactly replicated, medicines made from living cells cannot be precisely copied, earning them the designation of biosimilars rather than generic equivalents.
Broader Formulary Strategy
The Stelara transition represents part of Caremark (search)'s expanded biosimilar coverage initiative across select specialty categories. The pharmacy benefit manager is implementing similar changes for treatments addressing multiple sclerosis (search) and rare blood disorders (search), signaling a systematic approach to biosimilar integration.
Formularies serve as curated lists of prescription medications available under health plans, managed with support from pharmacy benefit managers who act as intermediaries between employers and health plans. These decisions directly influence which medications patients can access and at what cost.
Industry Impact
Johnson & Johnson did not immediately respond to requests for comment regarding the formulary exclusion. The pharmaceutical giant's Stelara has been a significant revenue generator, making this formulary change potentially impactful for the company's specialty medicine portfolio.
The move by CVS Health, one of the largest pharmacy benefit managers in the United States, could influence other insurers and PBMs to make similar transitions to biosimilar alternatives, potentially accelerating the adoption of these lower-cost therapeutic options across the healthcare system.