Evernorth, the health services arm of insurance behemoth Cigna, is planning to make a Stelara biosimilar available for $0 out-of-pocket for select patients.
The move, announced Thursday, applies to eligible patients at Evernorth’s specialty pharmacy, Accredo, which focuses on patients with more complex or chronic health conditions. The biosimilar will be produced by Quallent Pharmaceuticals, another Cigna company, which collaborates with Boehringer Ingelheim and should be available to patients beginning in early 2025.
Evernorth says that the no-cost, out-of-pocket option will be available “for most patients through Quallent’s copay assistance program.”
The announcement replicates an earlier plan to make AbbVie’s Humira similarly available for $0 out-of-pocket for some patients, which Evernorth estimated would save individual patients about $3,500 a year. Cutting out-of-pocket costs for Stelara is expected to save patients more — about $4,000 a year.
More than 30,000 patients across Accredo use Stelara, Johnson & Johnson’s treatment for plaque psoriasis and inflammatory bowel disease. The biosimilar price will be 80% lower than the drug’s list price, according to Evernorth. As of March 2022, the list price of Stelara for patients with Crohn’s disease was roughly $25,500 every eight weeks for the 90 mg dose.
How quickly Accredo patients switch over is yet to be determined. After the Humira biosimilar was made available in June, more than 25% of eligible Accredo patients switched over from the brand name to the biosimilar. But the patient population with Humira is much larger than for Stelara, with more than 100,000 patients in the pharmacy network using either Humira or one of its biosimilars at the time of the announcement.
Stelara pricing pressure has also come from Washington, after the drug was included in Medicare’s first round of price negotiations stemming from the Inflation Reduction Act. The government said it brought the list price of the drug down from $13,386 to $4,695.
Johnson & Johnson previously said that the impact of the IRA was baked into its financial guidance, noting that Stelara’s lost exclusivity made its inclusion in the list more manageable. The large pharma company has looked to offset the significant revenue stream by expanding Tremfya into IBD.
CEO Joaquin Duato told investors at the annual Morgan Stanley Healthcare Conference on Wednesday that they’re “going to see Tremfya in IBD being a major growth driver.”