Last summer, pharmacy benefits giant Express Scripts tossed Novartis’ psoriasis drug Cosentyx out of its 2021 formulary in favor of Eli Lilly’s lower-cost Taltz. Now Cigna, which owns Express Scripts, is offering $500 to some patients who make the switch—an offer that could set a precedent as the anti-inflammatory market approaches a major biosimilar shakeup, one analyst suggested.
In a letter to doctors in March, some plans run by Cigna Pharmacy said patients could receive a $500 debit card if they switch from Cosentyx to Taltz or an older biologic before Aug. 31 and then refill the prescription before the end of this year. The letter was obtained by the American Journal of Managed Care.
The move comes as biosimilar developers prepare to launch low-cost rivals to another psoriasis remedy that happens to be the world’s best-selling drug—AbbVie’s Humira—in 2023. Bernstein analyst Ronny Gal called Express Scripts' offer to Taltz switchers a “general rehearsal for Humira” in a note to investors Monday.
“The timing is no coincidence in our mind,” Gal wrote. Express Scripts, “like other payers, is working on their toolkit to switch patients from Humira to biosimilar Humira in 2023. The more comfortable the PBM (and its clients) can [be] that the switch will be near-complete, the more assertive they can be in the 2022 negotiations … with AbbVie and the biosimilar developers.”
Express Scripts’ efforts to persuade psoriasis patients to abandon Cosentyx are working, Gal noted. Prescriptions for Cosentyx dropped 17% in the first two months of this year, while Taltz scripts fell just 4%, according to IMS data acquired by Bernstein. Among dermatologists, Taltz is already the No. 1 choice, the analyst reported.
The psoriasis market was already hyper-competitive, and formulary changes will only serve to intensify the rivalries. Cosentyx and Taltz, both IL-17 inhibitors, are facing competition from AbbVie’s IL-23 blocker Skyrizi, which Express Scripts chose as a “preferred alternative” to Cosentyx in the new formulary.
AbbVie no doubt earned that preferred placement with stellar head-to-head data on Skyrizi. In a phase 3 trial reported last June, 66% of psoriasis patients taking Skyrizi saw clear skin after four months, compared with 40% of patients on Cosentyx.
Combined sales of Skyrizi and AbbVie’s other new anti-inflammatory, Rinvoq, came in at $2.3 billion last year and are expected to double this year. AbbVie is gunning for a spot in the psoriatic arthritis market with Rinvoq, a JAK inhibitor, but that effort hit a snag last month when the FDA asked for more data on the product’s risk-benefit profile in that disease.
Cigna's $500 offer to patients who abandon Cosentyx is not a new idea, Bernstein’s Gal noted. UnitedHealthcare tried something similar in 2018 with HIV drugs, offering $500 in prepaid debit cards that patients could use to pay medical expenses if they switched to low-cost HIV regimens.
That program failed, largely because of pushback from HIV drugmaker Gilead Sciences and other players, but this psoriasis incentive could be different, Gal suggested. That’s because psoriasis is not a progressive disease, and Cosentyx and Taltz are similar, he said.
If Cigna does switch a lot of patients to Taltz, expect other insurers to follow suit, Gal said. “If successful, the use of cash tools by payers will reasonably proliferate,” he wrote.