Biosimilars emerge as a potential next direct-to-employer drug strategy

A recent announcement points to a new direct-to-employer model for biosimilars:
Waltz Health and Fresenius Kabi said employers, payers and PBMs will be able to access three biosimilars through Waltz Health’s platform, building on its direct-to-payer program for anti-obesity GLP-1 medicines.

The products named are adalimumab-aacf, a Humira biosimilar; Otulfi (ustekinumab-aauz), a Stelara biosimilar; and Tyenne (tocilizumab-aazg), an Actemra biosimilar. The offer uses transparent, per-unit pricing.

The broader employer trend is cost control:
employers are increasingly steering members toward lower-cost biosimilars where clinically appropriate, while reassessing GLP-1 coverage and considering drug arrangements outside traditional PBM channels.

Adoption still has room to grow. A CVS Caremark survey reported that 49% of employers encourage biosimilar substitution, while 40% are considering or exploring it. The same report cited more than $3.3 billion in gross Humira-related savings for its clients and members since April 2024.

The key question for employers is whether direct access delivers better net costs and member access than their existing PBM formulary. Transparent prices alone do not establish total savings; plans should compare rebates, fees, clinical support, and out-of-pocket costs.