Express Scripts will prefer the first Food and Drug Administration-approved interchangeable biosimilar product, a move it says will lead to millions in savings.
Semglee, which was developed by Viatris, was approved by the FDA in late July. Express Scripts will move the product to its National Preferred Formulary, which reaches 28 million members. By making the change, the pharmacy benefit manager estimates it could achieve $20 million in savings in 2022.
In addition, Express Scripts said Sanofi's biologic insulin injection Lantus will be excluded from its National Preferred Formulary.
Semglee will also be included in Express Scripts' Patient Assurance Program, which caps member copayments at $25 for up to a 34-day supply of included diabetes medications.
“We have advocated for more than a decade for a safe and effective pathway to bring biosimilars to market because they hold tremendous promise for cost savings for patients, plans and our entire health care system,” said Amy Bricker, president of Express Scripts, in a statement.
“The FDA approval of the first interchangeable biosimilar signals an historic opportunity to realize these cost-savings for our clients and members," Bricker said. "This important designation is another milestone toward a pathway for the full adoption of biosimilars, which is critically important to making high-cost medications more affordable for patients, employers and health plans.”
The biosimliar drug will also be added to Express Scripts' SafeGuardRx Diabetes Care Value program, the PBM said, which is a high-touch, value-based program that aims to improve outcomes in diabetes.
Express Scripts and other major PBMs believe biosimilars will be a critical tool in driving down the high cost of drugs, particularly for pricey specialty medications where they can serve as equivalents. Data from Evernorth, the PBM's parent company and the health services division of Cigna, estimate that biosimilars could cut down drug spending by $225 billion to $375 billion over the next decade.
“For patients with diabetes, affordable access to insulin can be lifesaving,” said Bricker. “We believe in the power of biosimilars to drive greater savings for diabetes medications without sacrificing clinical effectiveness or patient safety.”