CVS Health said Tuesday that, effective July 1, it will prioritize lower-cost, interchangeable biosimilars over Johnson & Johnson's psoriasis treatment Stelara on its most commonly used drug lists.
The company’s pharmacy benefit management division, Caremark, will make the change by transitioning covered patients to biosimilar alternatives including Sandoz's Pyzchiva and Biocon Biologics' Yesintek. CVS said most members will pay no out-of-pocket costs for their therapy under the revised coverage approach.
CVS Health's shares slid 1.4% on Tuesday following the announcement.
Joshua Fredell, a senior vice president at CVS Health, framed the move as a way to reduce costs for clients while broadening access to established treatments. He said expanding use of FDA-approved biosimilars enables significant savings for clients and supports wider, more affordable access to proven therapies.
"Expanding adoption of FDA-approved biosimilars allows us to deliver significant savings for clients while supporting broader, more affordable access to proven therapies," said Joshua Fredell, senior vice president at CVS Health.
The company emphasized that the switch will use interchangeable biosimilars, a regulatory designation that allows substitution under certain conditions. The announcement noted an important scientific distinction: biologic medicines, which are produced from living cells, cannot be replicated exactly in the way conventional pill-based generics can, and so near-equivalent versions are described as biosimilars.
Caremark also said it is broadening biosimilar coverage into selected specialty categories beyond this change, citing treatments for conditions such as multiple sclerosis and selected rare blood disorders. The company characterized the expansion as targeted to select specialty categories rather than a wholesale replacement across all classes.
The change affects formularies - the lists of prescription medications available under health plans that are managed with support from a pharmacy benefit manager. PBMs act as intermediaries for employers and health plans, shaping which products are preferred and how costs are shared for patients.
The move to prioritize biosimilars for Stelara reflects a PBM-driven effort to lower drug spending through substitution to lower-cost alternatives where regulators have approved such options. CVS’s action highlights how formulary design and PBM policies can influence access and out-of-pocket costs for specialty therapies.
What this means:
- Caremark will place interchangeable biosimilars of Stelara on its most common drug lists starting July 1.
- Most members affected by the switch are expected to face no out-of-pocket charge for their therapy.
- Caremark is expanding biosimilar coverage across select specialty categories, including therapies for multiple sclerosis and certain rare blood disorders.