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UnitedHealth's 2017 Formulary to Support Generic and Biosimilar Drugs

Surabhi Dangi-Garimella, PhD
UnitedHealth has posted a presentation on its website that provides an update to its pharmacy benefits and prescription drug lists for 2017.
Basaglar, biosimilar to Lantus; Zarxio, biosimilar to Neupogen; and generic imatinib mesylate (Gleevec), will replace their respective reference products on UnitedHealth’s formulary in 2017. The health plan’s proposal follows similar such exclusions that were released by major pharmacy benefit managers, Express Scripts and CVS Health, about a month back.

UnitedHealth has posted a presentation on its website that provides an update to its pharmacy benefits and prescription drug lists (PDLs), and also explains the various aspects of the company’s PDL decision-making process, which includes financial, clinical, market impact, and pharmacoeconomic evaluations. With a focus on specialty medications—high-cost prescription medications that often need special handling and administration—the company shares statistics on specialty medications: they represent between 1% to 2% of utilization but more than 36% of UnitedHealth’s costs.

The following are some of the changes to important drug categories that will be made to UnitedHealth’s formulary come January 1, 2017:

Category Drug Change
Diabetes Lantus Excluded
Basaglar Tier 1
Levemir Tier 2
Multiple sclerosis Plegridy Will be covered
Aubagio Step therapy not required
Gilenya Step therapy not required
Pain management OxyContin Excluded
Butrans Excluded
Sumavel DosePro Excluded
Xtampza ER Tier 3
Neutropenia Neupogen Excluded
Zarxio Replace Nepogen
Cancer Sprycel Excluded
Gleevec Excluded
Imatinib Replace Gleevec
Tasigna Step therapy;

step 1 medication: imatinib

Analysts from Barclays are not surprised with the biosimilar swap chosen by UnitedHealth. “Branded biologic exclusions could extend into other categories such as inflammation or oncology,” they told investors, according to FiercePharma. Ronny Gal, with Bernstein, predicted payer support will definitely help boost the biosimilar market, considering recent formulary decisions by both Express Scripts and CVS Health, in addition to UnitedHealth. “[W]e would argue it materially increases the likelihood that Enbrel and Humira will see similar exclusions when biosimilars arrive,” Gal noted.

The company has also taken a significant policy stand by excluding the 2 pain drugs OxyContin and Butrans from the PDL citing “aggressive drug marketing of opioids.” The actions will also help them comply with changes announced by the CDC in March 2016, which includes modifying the prior-authorization criteria.

Gal noted that “[W]e are seeing commercial payors making more aggressive steps to control formulary costs,” but acknowledged that these changes are being made at a significantly faster rate than what analysts had expected.

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