Table 1.
Variation in biosimilar coverage by included health plans
| Health plan | Payer size | Serviced by one of the Big Three PBMsa | Coverage policies, N | Coverage no more restrictive than the reference product, N (%) | Coverage more restrictive than the reference product, N (%) |
|---|---|---|---|---|---|
| Aetna | National | Yes | 76 | 54 (71.1) | 22 (29.0) |
| Anthem | National | No | 55 | 37 (67.3) | 18 (32.7) |
| BCBSFL | Regional | No | 73 | 63 (86.3) | 10 (13.7) |
| BCBSMA | Regional | Yes | 75 | 73 (97.3) | 2 (2.7) |
| BCBSMI | Regional | Yes | 60 | 57 (95.0) | 3 (5.0) |
| BCBSNC | Regional | No | 72 | 64 (88.9) | 8 (11.1) |
| BCBSNJ | Regional | No | 76 | 74 (97.4) | 2 (2.6) |
| BCBSTN | Regional | Yes | 66 | 50 (85.5) | 16 (24.2) |
| CareFirst | Regional | Yes | 66 | 42 (63.6) | 24 (36.4) |
| Centene | National | No | 68 | 68 (100.0) | 0 (0.0) |
| Cigna | National | Yes | 76 | 76 (100.0) | 0 (0.0) |
| Emblem | Regional | Yes | 64 | 39 (60.9) | 25 (39.1) |
| HCSC | National | No | 60 | 43 (71.7) | 17 (28.3) |
| Highmark | Regional | No | 76 | 59 (77.6) | 17 (22.4) |
| Humana | National | No | 76 | 41 (54.0) | 35 (46.1) |
| IndepBC | Regional | No | 66 | 39 (59.1) | 27 (40.9) |
| United | National | Yes | 76 | 73 (96.1) | 3 (4.0) |
| Total | – | 1181 | 952 (80.6) | 229 (19.4) |
Payer size and PBM servicing data were retrieved from the respective health plans’ websites in December 2022. Percentages may not add up to 100% due to rounding
PBM pharmacy benefit manager
aThe Big Three included CVS Caremark, Express Scripts, and OptumRx