White-glove support during a biosimilar transition

Provided by AAFP partner

Author: Lucille Accetta, RPh, MPH, MBA, Senior Vice President & Chief Pharmacy Officer of Specialty Pharmacy Operations, CVS Health

Autoimmune conditions treated with Humira^® have been among the top drivers of specialty drug costs for years. To improve affordability and maintain clinical integrity, CVS Caremark^® removed Humira from major national commercial template formularies and prioritized adalimumab biosimilars starting April 1, 2024.¹ This shift required months of planning and collaboration across CVS Caremark and CVS Specialty^® to ensure a smooth experience for prescribers and patients. 

Operationalizing the biosimilar transition with prescribers 

Humira is CVS Specialty’s highest-volume specialty medication, so the transition demanded a detailed approach. Our teams identified impacted patients early and reached out to prescribers with clear guidance. To reduce uncertainty, the Quality Team mapped Humira doses and strengths to the most clinically aligned biosimilars. Prescribers received prescription change requests listing covered alternatives and patient-specific mapping. With one click, they could approve a biosimilar and notify the pharmacy—streamlining the process. For practices without electronic messaging, outreach included phone and fax, with early communication to allow time for questions and follow-up. 

Drug shortages and supply chain challenges have disrupted care in recent years. To stabilize access, CVS Health launched Cordavis^™, focused on delivering safe, affordable biosimilars and fostering marketplace competition. CVS Specialty partnered with Cordavis to maintain reliable inventory while fulfillment teams projected volumes to keep pharmacies stocked. Patient support teams also helped eligible members enroll in copay assistance programs. Daily coordination and an internal feedback loop ensured rapid issue resolution and kept the transition on track. 

Communicating with patients always, in all ways 

Many patients have taken specialty medications for years and needed reassurance about biosimilars. CVS Specialty developed robust educational resources on CVSspecialty.com, including videos, FAQs, and trusted third-party content.

With an increase in digital engagement amongst patients, we used a digital-first approach to share information on safety, efficacy, and copay assistance. Patients praised representatives for proactive communication and hands-on support throughout the process. 

Results that matter

By April 1, 2024, prior authorizations were secured, copay assistance delivering $0 out-of-pocket for eligible patients was in place, and prescriptions were filled without delay. Contrary to expectations, inbound call volume did not spike; some patients even requested early switches. NPS scores rose during the transition, reflecting confidence and satisfaction.²

The overall patient sentiment was that they were embracing the change and were excited to experience the savings—now and in the months and years to come.

Explore CVS Specialty’s biosimilar prescribing resources and streamlined tools to help make transitions easier for your patients.

References 

1. As of May 25, 2024, adalimumab includes: Humira, Hyrimoz, Hadlima, Adalimumab-adaz, Amjevita, Adalimumab-aacf (2 pen), Hulio, Adalimumab-fkjp, Idacio, Yuflyma, Adalimumab-adbm, and Cyltezo.

2. The source of the results is Medallia Specialty Care and Specialty Order survey, 1/1/24 – 6/30/24.

Note: Humira continues to be an option for clients with Choice and Standard Opt Out commercial formularies.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health. 

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