The Warped Incentives Behind Amgen’s Humira Biosimilar Pricing

As you've surely heard, Amgen has just launched Amjevita, the first non-interchangeable biosimilar of Humira. Our crazy drug channel led Amgen to launch both a high-list/high-rebate and a low-list/low-rebate version of the drug. Its strategy echoes the pricing of the first interchangeable insulin biosimilars—as I predicted in 2021. 

Unfortunately, we should expect most PBMs and plan sponsors to embrace the high-list/high-rebate version. The plans that adopt the higher-priced biosimilar will get bigger rebates, while patients with coinsurance and deductibles end up paying more out-of-pocket. 

As Mark Twain said: “History doesn’t repeat itself—but it often rhymes.” So, below, I revisit the surprising market dynamics for the interchangeable insulin biosimilars and highlight Amgen’s experience lowering the list price of its PCSK9i product. The story is more complex than you might expect, so perhaps there is hope that low-list-price versions will connect.
AMGEN AGAIN 

Amgen is major biosimilar player, so it’s fitting that the company launched the first Humira biosimilar. Here’s the official press release: Amjevita™ (adalimumab-atto), First Biosimilar To Humira®, Now Available In The United States. As the release notes, Amjevita will be available at different two wholesale acquisition cost (WAC) list prices: a price that is 5% below Humira’s current WAC, and a price that is 55% below Humira’s current WAC. 

On its recent earnings call, Amgen was unambiguous about its rationale for the dual-pricing strategy:
“With respect to the two list price approach that we've employed here at this launch, this is really to address the complexity of the U.S. market. Pharmacy benefit managers have a business model that requires that they negotiate rebates with manufacturers, and so they would prefer a high list price and negotiate rebates to net the price down and then pass those rebates through to their upstream employer clients.”

While true, market access conspiracy theorists will also see Amgen signaling the minimum rebate level for its Humira biosimilars. I presume the later entrants will get the message. 

Also notable: Amgen plans to provide patient hub services for its biosimilars that are comparable to a brand-name drug. From the earnings call:
“In addition, of course, we provide nurse support for patients. And then while it wasn't asked, I think it's also important to note that we are providing financial assistance, support and reimbursement support for both prescribers and patients as we launch the product. So really a full suite of services and support that you would expect for a branded launch being applied to the launch of the first biosimilar, adalimumab, to launch in the U.S., that is AMJEVITA.”
FYI, Amgen has stated that the readout from Amjevita’s Phase III interchangeability study will be available in the first half of 2023. 

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