Health Plans Continue to Favor Longer-Marketed Brands for Immune Biologics Therapies

Despite Advantages of Newer Therapies, Health Plans Continue to Favor Immune Biologics Therapies with Known Track Records, According to New HealthLeaders-InterStudy and Fingertip Formulary Report

NASHVILLE, Tenn. & GLEN ROCK, N.J.--(BUSINESS WIRE)-- HealthLeaders-InterStudy and Fingertip Formulary find that health plans continue to favor longer-marketed brands for immune biologics therapies. A majority of surveyed pharmacy directors indicate that they look for better efficacy when determining which therapies receive preferential formulary placement, according to the recent Formulary Forum report entitled Formulary Advantages in Immune Biologic Therapies Health Plans.

Tiering data from this report shows that surveyed health plans have increased their better tier coverage (Tier 1 or 2 placement) of some new therapies in the past year but continue to offer the best tier positions for the longer-marketed brands such as Enbrel and Humira

“What’s interesting is that newer drugs such as Centocor Ortho Biotech’s Simponi have advantages over older therapies,” said HealthLeaders-InterStudy Senior Analyst Roy Moore, an author of the report. “But health plans have yet to put them on the same tiers as Enbrel and Humira.”

Larger commercial plans representing 15 percent of lives have moved Centocor Ortho Biotech’s Simponi to Tier 1 or 2 in the past year, but its formulary access still trails behind Enbrel and Humira. The survey of health plans conducted for the report found that 68 percent of plans viewed better safety/tolerability as among the three most important attributes for a brand. This finding suggests that plans may have chosen not to reimburse for newer therapies on the same tier as longer-marketed drugs until they have more post-marketing safety data on these newer therapies.

Despite the prevalence of numerous immune biologics therapies, 52 percent of surveyed health plans report increased spending on rheumatoid arthritis (RA) over the past five years compared with just 4 percent that saw medical costs decrease, suggesting they are not getting value from increased spending on prescription drugs. During this time, 76 percent of surveyed plans reported spending more on prescription drugs to treat RA, according to the report.

The new Formulary Forum report is based on a survey of 50 U.S. pharmacy directors who control formularies at national, regional and state-level managed care organizations, as well as historical formulary data from Fingertip Formulary. To view an abstract of this report please click here.

About Fingertip Formulary

Fingertip Formulary (, the leading provider of access to and insight into formulary data in the United States, offers comprehensive formulary data covering commercial, Medicaid, Medicare and PBM plans, among others. Fingertip Formulary is a Decision Resources, Inc. company.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Both HealthLeaders-InterStudy and Fingertip Formulary are Decision Resources, Inc. companies. Please visit Decision Resources, Inc. at

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.


Kristi Guillemette, 781-993-2618
[email protected]
Decision Resources, Inc.
Elizabeth Marshall, 781-993-2563
[email protected]

KEYWORDS:   United States  North America  New Jersey  Tennessee

INDUSTRY KEYWORDS:   Health  Biotechnology  Hospitals  Infectious Diseases  Pharmaceutical  Professional Services  Insurance  Research  Science