For 2025, the three largest pharmacy benefit managers (PBMs)—Caremark (CVS Health), Express Scripts (Cigna), and Optum Rx (United Health Group)—have again each excluded hundreds of drugs from their standard formularies. You can find our updated counting below.
As you’ll see below, the combination of formulary exclusion and private labels is creating an increasingly confusing and crowded biosimilar marketplace.
For 2025, the Big Three PBMs shifted national formularies to favor their private-label biosimilars over Humira and its many biosimilar competitors. In fact, nearly all marketed Humira biosimilars are excluded from the larger PBMs’ 2025 formularies. Meanwhile, Stelara—this year’s big pharmacy benefit biosimilar launch—remains on the PBMs’ formularies, but will share space with PBMs’ private label products.
Like it or not, PBMs’ financial benefits from their private-label product align with the benefits to plan sponsors and patients. But the PBMs’ strategies, combined with the warped incentives baked into the Inflation Reduction Act, raise questions about the viability of the biosimilar marketplace.
What do you think? I encourage you to share your thoughts with the Drug Channels community on LinkedIn.
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