加州蓝盾公司通过新的Humira生物仿制药交易避开PBM-动脉网

Blue Shield of California sidesteps PBMs with new Humira biosimilar deal

HealthcareDive 等信源发布 2024-10-03 10:18

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Dive Brief:

潜水简介：

A major California health plan has struck a novel deal directly with a drug manufacturer for a cheaper version of Humira, cutting out pharmacy benefit managers — controversial middlemen in the drug supply chain that typically control access to medication — entirely.

加利福尼亚州的一项重大健康计划直接与一家药品制造商达成了一项新协议，购买更便宜版本的Humira，彻底淘汰了药房福利经理——药品供应链中有争议的中间商，通常控制药品的获得。

As a result of the deal, Blue Shield of California will purchase a Humira biosimilar for $525 per monthly dose, significantly below the drug’s net price of $2,100.

根据该协议，加州蓝盾将以每月525美元的价格购买Humira生物仿制药，大大低于该药2100美元的净价。

The biosimilar will be available for most of BSCA’s commercial members at $0 co-pay starting Jan. 1, 2025, according to the insurer, which announced the deal Tuesday.

该保险公司周二宣布了这项交易，该公司表示，自2025年1月1日起，BSCA的大多数商业会员将以0美元的共同支付价格获得生物仿制药。

Dive Insight:

潜水洞察：

Blue Shield of California, or BSCA, is one of the largest health plans in America’s most populous state, with more than 4.8 million covered lives. It’s also proved more willing than others to take drastic action to lower drug costs, recently rolling out an unusual pharmacy benefits arrangement that chopped up functions normally performed by one PBM and divvying them up to multiple vendors instead.

加州蓝盾计划（BSCA）是美国人口最多的州最大的健康计划之一，覆盖了480多万人的生命。事实证明，它比其他公司更愿意采取剧烈行动来降低药品成本，最近推出了一项不寻常的药房福利安排，将通常由一家PBM执行的功能分割开来，并将其分配给多家供应商。

BSCA expects that arrangement to save hundreds of millions of dollars each year..

BSCA预计这一安排每年将节省数亿美元。。

Now, BSCA is targeting AbbVie’s blockbuster drug Humira as its latest pathway to cut costs.

现在，BSCA将AbbVie的畅销药Humira作为其削减成本的最新途径。

Humira, which treats a variety of inflammatory conditions like arthritis and Crohn’s disease, is one of the top-selling drugs ever — and a peak example of how medications can be lifesaving for patients while creating a crippling financial burden on the U.S. health system.

Humira治疗关节炎和克罗恩病等多种炎症性疾病，是有史以来最畅销的药物之一，也是药物如何挽救患者生命，同时给美国卫生系统带来沉重经济负担的一个高峰例子。

At a list price around $7,000 per dose, Humira has been massively lucrative for AbbVie. Since the Chicago-based drugmaker launched Humira more than two decades ago, AbbVie has brought in nearly $200 billion in sales through 2023, when Humira’s patent expired and the first copycat version of the injectable launched..

以每剂7000美元左右的标价，Humira对AbbVie来说利润丰厚。自从这家总部位于芝加哥的制药商在20多年前推出Humira以来，到2023年，AbbVie已带来近2000亿美元的销售额，当时Humira的专利到期，该注射剂的第一个复制版本发布。。

Currently, there are 10 Food and Drug Administration-approved biosimilars of Humira available at a significantly lower cost. However, the availability of alternatives has not significantly lowered Humira’s price.

目前，有10种食品和药物管理局批准的Humira生物仿制药可用，成本明显较低。然而，替代品的可用性并没有显着降低Humira的价格。

BSCA spends well over $100 million annually on Humira, more than any other medication, according to a spokesperson for the insurer.

BSCA的一位发言人表示，BSCA每年在Humira上的花费远远超过1亿美元，超过任何其他药物。

Biosimilars are often out of reach for payers and their members because of how PBMs craft formularies, or lists of covered drugs.

由于PBM如何编制处方集或涵盖药物列表，支付者及其成员通常无法获得生物仿制药。

PBMs receive rebates from pharmaceutical manufacturers in exchange for placing their medications in a favorable position on the formulary. Generally, the pricier the drug, the larger the rebate. PBMs have been accused of prioritizing high-cost brand name drugs on their formularies — and hesitating to adopt biosimilars — as a result..

。一般来说，药品价格越高，回扣就越大。因此，PBM被指控在其处方集中优先考虑高成本品牌药物，并犹豫是否采用生物仿制药。。

Switching all Humira patients to biosimilars would save the U.S. health system up to $6 billion — but PBMs would lose up an estimated 84% of their profits from the drug, according to life sciences consultancy Iqvia.

根据生命科学咨询公司Iqvia的数据，将所有Humira患者转换为生物仿制药将为美国卫生系统节省多达60亿美元，但PBM将损失其从该药物中获得的利润的84%。

For its new biosimilar arrangement, BSCA negotiated directly with a subsidiary of German manufacturer Fresenius, with the help of Evio Pharmacy Solutions, a company owned by Blues plans including BSCA. As a result, BSCA can get a Humira biosimilar without the traditional markups created by PBMs, according to the insurer..

对于其新的生物仿制药安排，BSCA在Evio Pharmacy Solutions的帮助下，直接与德国制造商费森尤斯（Fresenius）的子公司进行谈判，Evio Pharmacy Solutions是一家由包括BSCA在内的Blues plans所有的公司。因此，据保险公司称，BSCA可以获得Humira生物仿制药，而无需PBMs创造的传统加价。。

It’s the first time this type of model has been used to bring a Humira biosimilar to market, according to BSCA — and yields a much lower cost than both the brand-name version of the drug and its biologic copycats.

据BSCA称，这是这种类型的模型首次用于将Humira生物仿制药推向市场，其成本远低于该药物的品牌版本及其生物仿制药。

The $525 price tag for BSCA compares to $584 for a Humira biosimilar at Mark Cuban Cost Plus Drug Company, or about $1,300 for one produced by Cordavis, a manufacturing subsidiary of CVS, for example.

BSCA的价格为525美元，而Mark Cuban Cost Plus Drug Company的Humira生物仿制药价格为584美元，CVS的制造子公司Cordavis生产的仿制药价格约为1300美元。

“We will no longer take part in a pharmacy system that is designed to maximize the profit of participants instead of the quality, convenience, and cost-effectiveness for consumers,” BSCA CEO Paul Markovich said in a statement.

BSCA首席执行官保罗·马科维奇（PaulMarkovich）在一份声明中表示：“我们将不再参与旨在使参与者利润最大化，而不是为消费者提供质量、便利和成本效益的药房系统。”。

BSCA is looking into applying this model to other pricey brand-name drugs, too. A number of widely prescribed drugs, including Merck’s Keytruda and Amgen’s Enbrel, will lose their patent protection in the next few years.

BSCA也在研究将这种模式应用于其他昂贵的品牌药物。包括默克公司（Merck）的Keytruda和安进公司（Amgen）的Enbrel在内的许多处方药将在未来几年失去专利保护。

“This is just one of many biosimilars to come,” a BSCA spokesperson said.

BSCA发言人表示：“这只是众多生物仿制药中的一种。”。

Major PBMs — notably CVS’ Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx — have said they’re prioritizing biosimilar access amid rising criticism for their role in driving up U.S. drug costs.

主要的PBM，特别是CVS的Caremark、信诺的Express Scripts和UnitedHealth的Optum Rx，都表示他们正在优先考虑生物仿制药的使用，因为越来越多的人批评他们在推高美国药品成本方面的作用。

Caremark, the largest PBM in the nation, launched Cordavis to produce and market biosimilars, and removed brand-name Humira from most of its major commercial formularies this spring.

Caremark是国内最大的PBM，它推出了Cordavis生产和销售生物仿制药，并于今年春季将品牌Humira从其大多数主要商业配方中删除。

Similarly, Express Scripts announced it would remove Humira from its largest commercial formulary in favor of multiple biosimilars this summer. The PBM also has a subsidiary that markets Humira biosimilars called Quallent Pharmaceuticals.

同样，Express Scripts宣布今年夏天将从其最大的商业处方集中删除Humira，转而使用多种生物仿制药。PBM还有一家销售Humira生物仿制药的子公司，名为Quallent Pharmaceuticals。

Optum Rx is also removing brand-name Humira from some of its preferred formularies in favor of a less expensive version starting in 2025.

Optum Rx还将品牌Humira从其一些首选配方中删除，以支持从2025年开始推出更便宜的版本。

Much of the concern swirling around PBMs stems from the vertical integration of the three largest players. Caremark, Express Scripts and Optum Rx are all owned by massive healthcare conglomerates that also include a national health insurer and pharmacy network.

围绕PBM的大部分担忧源于三大参与者的垂直整合。Caremark、Express Scripts和Optum Rx均为大型医疗保健企业集团所有，这些企业集团还包括一家国家健康保险公司和制药网络。

Now, lawmakers are flagging additional worries about those PBMs stepping into the marketing of biosimilar and generic drugs.

现在，立法者们对这些PBM进入生物仿制药和仿制药的营销表示担忧。

On Tuesday, two top Senate Democrats asked the Federal Trade Commission to investigate PBMs’ co-manufacturing practices, arguing that CVS’ and Express Scripts’ manufacturing subsidiaries further widen their already significant control over the pharmaceutical supply chain.

周二，两位参议院民主党高层要求联邦贸易委员会调查PBMs的联合制造做法，认为CVS和Express Scripts的制造子公司进一步扩大了其对药品供应链的重要控制。

The FTC sued the Big Three PBMs last month over anticompetitive concerns, including how PBMs’ rebating practices are allegedly driving up drug costs.

上个月，联邦贸易委员会（FTC）就反竞争问题起诉了三大PBM，其中包括PBM的退税做法如何导致药品成本上涨。