Cigna's Evernorth Unit Will Sell a Humira Biosimilar From Its Quallent Drug Company Through Its Accredo Pharmacy

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So big news: Cigna, via Evernorth, is going to start selling its own Humira biosimilar, making it available to health plans with a patient assistance option that would get the copay down to $0. 

Most of the coverage has focused on the last bit of that sentence, emphasizing how nifty is it that there’s a biosimilar with no copay. 

That’s entirely missing the point. 

One of the biggest insurers in the United States is vertically integrating all the way down to creating Quallent, its own Cayman Islands-based pharmaceutical company*. If you’re the kind of person who is generally suspicious of the way that big insurance companies are gobbling different parts of the supply chain as a way to maximize profits, you should be getting goosebumps.** 

I’m trying to work through the math here on who wins and who loses through this move. It’s not easy … the Cigna announcement was actually made through its Evernorth unit, which mentions -- in the very first paragraph -- two other subunits at the core of the new program: the Quallent pseudo-pharma group and the Accredo specialty pharmacy. 

Again, all of those entities are owned by Cigna. 

To track it all, I’m probably going to need a corkboard, a box of pushpins, some yarn, a map of the Caribbean, and 8x10 colored glossy photographs of Matt Perlberg, David Cordani, and whoever the heck runs Quallent, with circles and arrows and a paragraph on the back of each one explainin’ what each one was.

But at the most basic level, I’m assuming that Cigna/Evernorth will win by siphoning money that would otherwise go to a manufacturer. AbbVie will lose, because Humira volume will drop. The real biosims companies are somewhere in the middle, giving up revenue to Cigna in return for heretofore-hard-to-come-by volume. Plans will probably lose somewhat, because Evernorth sounds like it will be offering a cheaper -- but not the cheapest -- open. And patients should be fine, though when the health system gets more inscrutable, it’s usually patients that end up paying for it in the long run. 

But that’s a back-of-the-envelope assessment. I hope that someone is going to write a great explainer on this and -- when they do -- I’ll link to it. 

* Technically, they’re calling it “Evernorth's affiliate private label pharmaceutical distributor.” Quallent isn’t going to to produce anything, as best I can tell, but will in all other respects function as a manufacturer for supply-chain reasons. I think -- but can’t be sure -- that this low-on-details Alvotech release is forming the foundation for the Quallent move. 

** As a reminder, CVS Caremark is also playing this game through its pseudo-pharma, Cordavis.

It feels like it’s been a light earnings season for IRA/health policy commentary, but these things go in cycles. There has been some chatter about the Medicare Part D redesign and how it might affect various companies and franchises. 

Gilead said that they’d take a small hit. (“We do expect an impact of the Part D redesign to be weighted toward our HIV business and expect our HIV growth in 2025 to be offset by the Part D redesign impact.”) BMS was a little more vague. (“In 2024, we don't anticipate significant impact across our portfolio across Eliquis, Revlimid or other brands. We do expect, though, more substantial changes to the Part D benefit next year since the products are impacted by the redesign.”)

• Vertex has found a path to make its cystic fibrosis med available in South Africa, STAT reports, though it’s not clear if the action will be enough to halt other efforts designed to break the company’s patents there. 

• There is a New England Journal of Medicine “Perspective” making the case that there isn’t a free market for pharmaceuticals in the United States, there never has been a free market, and government should, therefore, intervene all it wants in the name of access and innovation. The whole piece is kind of built around a straw man definition of what pharma voices mean when they talk about free markets for meds, but -- hey -- it’s NEJM, so you should probably check it out. 

• New-drug-price alert: Pfizer received the FDA clearance for its hemophilia B gene therapy. Beqvez will carry a $3.5 million list price, with all kinds of associated bells and whistles around reimbursement. 

• It’s a day that ends in “y,” so there is obesity news. This Colorado news, about an in-process effort to ensure state plans cover obesity meds, is interesting in that there seems to be a dispute about whether the financial benefits are being considered along with costs. Which is a nice framing. And Modern Healthcare made a bunch of calls to Medicare Advantage plan sponsors, and it turns out there’s not a lot of details about how, when, and where obesity drugs might get covered by plans.