MedOne is excited to announce the newest iteration of our Biosimilar Strategy! Effective April 4, 2025, MedOne will be preferring Otulfi®, as it is the lowest net cost biosimilar for the reference product Stelara.
This change is set to bring substantial savings, reducing costs by an impressive 96% (when compared to the list price of Stelara) for our clients and members who have been previously utilizing Stelara to treat Crohn's disease, ulcerative colitis, plaque psoriasis, or psoriatic arthritis.
Through our partnership with Mark Cuban Cost Plus Drug Company (MCCPDC), the cost of treatment using Otulfi will be between $4,000-6,000 annually compared to other treatments that cost $40,000+ annually.
Strategy Details
This shift will operate similarly to our Humira-to-Yusimry iteration of the Biosimilar Strategy. Otulfi will be placed on our T0 specialty list, like Yusimry, allowing plans that exclude specialty medications access to this cost-effective biosimilar.
Stelara will be removed from the PAP-eligible list. This change comes as Johnson & Johnson (J&J) has removed Stelara from their list of eligible drugs for manufacturer assistance. Current members utilizing the J&J Foundation will continue to access Stelara through the Foundation until no longer eligible. Upon notification that a member no longer is accessing Stelara through the J&J Foundation, the member will be transitioned to Otulfi and fill at MCCPDC.
Like Yusimry, indication-based exclusions will still apply.
Effective immediately, Stelara will no longer be included in our international sourcing program. The price to access Brand Stelara internationally exceeds the cost to fill Otulfi at Cost-Plus Drugs. The PCC team will work to transition patients to filling Otulfi domestically.
All-in-all, this iteration of our biosimilar strategy supports our overall mission: To provide members with access to the most appropriate prescription at the most affordable cost.
About Biosimilars
Biosimilars are a type of biologic medication that are safe and effective. Biosimilars are medications aimed to replicate the therapeutic safety and efficacy of medications already licensed in the market, which are termed as “reference products” by the Food and Drug Administration (FDA). When biosimilars are considered for market approval by the FDA, the main ingredient structure must be identical to the reference product, but the inactive ingredients (or “excipients”) may differ.
Because of this requirement, a biosimilar and its original biologic have the same treatment benefits and risks. They must also:
- Be administered in the same way
- Have the same strength and dosage form
- Have the same potential side effects
Because biosimilars are developed by different manufacturers from the manufacturer who produces the reference product, the result is competitive pricing of these already high-cost biologic medications, thus increasing access and coverage affordability for patients and payors. All the while, maintaining clinically effective treatments.
If you have any questions about biosimilars, the newest iteration of this strategy, or anything else relating to your pharmacy benefit, please reach out to your MedOne Account Team.