Specialty drugs continue to be one of the fastest‑growing drivers of employer healthcare costs – and medications like Humira® and Stelara® are often at the center of that pressure. For employers looking to responsibly manage their prescription drug spend without limiting access to care, biosimilars are becoming an increasingly important part of the solution.
To help make these savings more accessible, Capital Blue Cross is expanding its collaboration with the Mark Cuban Cost Plus Drug Company. Beginning May 1, Capital’s commercial prescription drug plans will include coverage for two lower‑cost biosimilar alternatives to Humira and Stelara.
This expansion builds on Capital’s early move to cover prescriptions filled through Cost Plus Drugs, an online pharmacy selling medications at transparent prices based on drug acquisition cost plus a small standard markup.
Continued Focus on Affordability
Gary Petruzzelli, Vice President of Pharmacy Strategy and Services at Capital Blue Cross, said it reflects a continued focus on affordability in the specialty drug market. For employers and their employees, it means access to clinically equivalent treatments at a fraction of the list price – helping manage pharmacy costs while ensuring members still receive the medications they depend on.
“By expanding our work with Cost Plus Drugs, we’re giving Capital Blue Cross employers and members access to lower‑cost alternatives to some of the most expensive and commonly prescribed specialty medications,” Petruzzelli said. “Biosimilars represent a meaningful opportunity to reduce overall healthcare spending, and this initiative helps ensure those savings reach people who depend on these medications.”
In 2022, Capital became the first insurer in the nation to cover prescriptions filled through Cost Plus Drugs. With its newest collaboration, Capital becomes the first health plan in Central Pennsylvania and the Lehigh Valley to make these lower-cost biosimilar options for Humira and Stelara available to commercial members through their prescription drug plan.
What Are the Cost Savings?
The biosimilars include:
Adalimumab‑fkjp, an interchangeable biosimilar for Humira, currently priced at $423 through Cost Plus Drugs (two 40 mg/0.8 mL pens). Humira’s current list price is around $8,000 for a 30-day supply.
Starjemza, an interchangeable biosimilar for Stelara, currently priced at $360 through Cost Plus Drugs (one 45 mg or 90 mg/0.5 mL dose) for a 30-day supply. Stelara’s current list price is around $30,000.
Actual member cost‑sharing will depend on the individual’s pharmacy benefit.
What is a Biosimilar?
Humira and Stelara are biologic medications, a class of drugs made from living cells, and commonly prescribed to treat chronic inflammatory and autoimmune conditions such as psoriatic arthritis, Crohn’s disease, and ulcerative colitis.
Biosimilars are similar but not identical to their original biologics. Like their biologic originator, biosimilars go through clinical trials and are required by the FDA to show the same effectiveness and side effects.
The major difference is price.
Biologics account for nearly half of U.S. prescription drug spending, despite representing only a small percentage of all prescriptions. Biosimilars are generally cheaper than biologics, with cost savings ranging from 10% to 37%.
As more biosimilars become available, they’re playing a growing role in helping patients and employers manage prescription drug costs.