Serve You Rx, a pharmacy benefit manager, has added two recently approved biosimilars to Stelara to its formulary, the company announced Thursday.
Milwaukee, Wisconsin-based Serve You Rx is an independent PBM serving insurance brokers, consultants, third-party administrators and their employer clients.
The two biosimilars it added to its formulary are Otulfi and Yesintek, which are used to treat patients for Crohn’s disease, ulcerative colitis, plaque psoriasis and psoriatic arthritis. A biosimilar is a medicine that is very similar in structure and function to a brand name biologic medicine, but is significantly cheaper. Stelara is about $20,000 per month, according to Serve You Rx CEO Justin Jasniewski, but the company will be able to help clients save about 96% with Otulfi and about 90% with Yesintek.
Traditionally, PBMs will still cover the brand name drug even if the low-cost biosimilars are available, leading to patients paying significantly more than necessary. But Serve You Rx is doing things differently.
“One of the things that we did is we created a new formulary that’s specific to us, called the Biosimilar Advantage Formulary that excludes the high cost reference products,” Jasniewski said in an interview. “And it essentially mandates that patients have to take the lower cost biosimilars first because it’s just like taking a generic drug for the most part, they’re essentially clinically identical.”
Otulfi will be dispensed exclusively through Mark Cuban Cost Plus Drug Company (Cost Plus Drugs). Cost Plus Drugs is a prescription drug company that cuts out pharmacy middlemen and negotiates directly with drug manufacturers to get cheaper prices.
Yesintek will be offered on Serve You Rx’s specialty pharmacy network, which is powered by Waltz Health. Waltz Health offers a marketplace called Waltz Connect where specialty pharmacies compete on quality, clinical outcomes and price. In April, the companies announced a partnership that gives Serve You Rx’s clients access to Waltz Connect. When a specialty prescription is submitted for a member, the platform redirects it to the most suitable pharmacy based on the member’s benefit design, price, turnaround time, fulfillment accuracy, member experience and adherence rate.
The companies plan to expand to more biosimilars in the future, noted Mark Thierer, co-founder and CEO at Waltz Health.
“This biosimilar announcement is actually just the beginning,” he said in an interview. “You’re going to see Waltz powering this intelligent routing for many high cost specialty meds. And it’s our expectation that Justin and our other customers will be using it from cancer care to GLP-1s. It’s a very long list, and there’s a mountain of money to be saved by collapsing the supply chain and making it easier for patients to get onto these medications.”
GoodRx has also launched initiatives for biosimilars. For example, it teamed up with Boehringer Ingelheim last year to provide its Humira biosimilar for an exclusive cash price of $550 per two-pack.
Photo: cagkansayin, Getty Images
