Biosimilar Adoption at National CooperativeRx

Biosimilars have become an increasingly important part of modern healthcare. As “highly similar” alternatives to brand name biologic drugs, they have no clinically meaningful differences from their reference products and are available at a lower cost.

The first biosimilar, Zarxio (Neupogen) was approved in the United States in 2015. However, it wasn’t until the launch of Humira (adalimumab) biosimilars in 2023 and 2024 that the market truly felt the impact of this new category of drug products.

Adoption of Humira Biosimilars

Humira, approved in the early 2000s to treat a broad range of autoimmune conditions, generated more revenue than any other drug in history. The introduction of its biosimilars offered the potential for significant marketplace savings.

National CooperativeRx embraced CVS Caremark’s proprietary ChangeRx process to lead the way in transitioning patients from Humira to their biosimilars as quickly as possible to maximize savings for our member groups. As of quarter 4, 2024, 97.4% of adalimumab claims had been converted to biosimilars, generating more than $5,000 in list price savings per claim.

The process was complex and detailed, especially since pharmacists cannot substitute a biosimilar for a reference product without the prescriber’s approval, as they can for non-biologic drugs. Many providers and patients were hesitant to change; they were unfamiliar with the rigorous standards and approval process for biosimilars and feared they would be less effective for the serious conditions they’re used to treat. Some patients fought to stay on the brand for fear of losing copay assistance with the biosimilar. CVS Caremark and National CooperativeRx worked together to educate patients and providers about the quality of biosimilars and the availability of copay assistance, ultimately resulting in robust acceptance of the biosimilar. 

Adoption of Stelara Biosimilars

In July 2025, CVS Caremark added Stelara (ustekinumab) biosimilars to their formulary, offering a list price savings of almost 90%; thus far, Stelara has remained on the formulary alongside the biosimilars. However, despite the option to keep patients on Stelara, the majority of patients and providers have elected to switch to a biosimilar when starting therapy or at prior authorization renewal. At the end of 2025, only seven months after their addition to formulary, 29% of National CooperativeRx’s ustekinumab utilization was in the biosimilars. Even providers who were the most hesitant to accept biosimilar Humira, gastroenterologists, are selecting biosimilar Stelara. This incredible uptake is attributable to the positive experience providers and patients have had with Humira biosimilars and the proactive approach of the National CooperativeRx Clinical Team to educate and provide one-on-one assistance when necessary.

Advancing Biosimilar Adoption

As we look forward to a growing biosimilar market, we acknowledge the factors that have contributed to our success thus far. Provider and patient education on the safety and efficacy of biosimilars has been a key component of achieving uptake. Additionally, making patients aware of available copay assistance for biosimilars has helped allay financial fears. Finally, most of our groups have the PrudentRx program, which assures patients of a $0 out-of-pocket cost for the biosimilar, regardless of available copay assistance. 

Biosimilar adoption is poised to become even smoother and simpler as we move forward.  Prescribers and patients have grown more comfortable with biosimilars and recognize the value to the healthcare system. Also, there is legislation in progress which would allow pharmacists to make the switch to biosimilars without prescriber consent, given the immense data demonstrating that biosimilars are equally effective to their corresponding reference products. Last, the sheer number of biosimilars in the pipeline will continue to make them more ubiquitous in the marketplace and normalize them as part of the pharmacy experience. 

Biosimilar Pipeline and Indications:

2026: 

• Simponi: Several types of arthritis, ulcerative colitis
• Xolair: Asthma, food allergy, nasal sinus inflammation, and chronic hives
• Eylea: Progressive eye disease resulting in loss of vision
• Lucentis: Progressive eye disease resulting in loss of vision

2027:

• Orencia IV: Several types of arthritis

2028:

• Entyvio: Crohn’s disease and ulcerative colitis
• Orencia SQ: Several types of arthritis

A Personalized Approach to Enhancing Patient Outcomes

As a pharmacy benefit cooperative, we exist to advance the success of our member groups and the well-being of their patients. Our in-house team works hand-in-hand with patients and their providers to understand individual needs and coordinate efforts that drive meaningful results. This personalized approach fosters trust, strengthens engagement, and ensures patients and providers have the resources and guidance necessary to achieve the best possible outcomes.

Our approach delivers results—enhanced care, real savings, and confident decision-making. Contact our team to learn more about how our Cooperative difference can support your plans and patients.