How are hospitals and 340B affecting the adalimumab market?
340B pricing may still favour branded Humira in the medical-benefit channel, and interchangeability designations vary by biosimilar and formulation — pharmacists now report that a prescription accepted by one PBM may be rejected by another for non-covered brand selection.
Adalimumab is dispensed through both pharmacy and medical benefit channels, and hospitals participating in the federal 340B drug discount programme can buy it at steep discounts. One market analysis noted that 340B pricing for Humira may continue to favour the branded product, creating a split incentive between pharmacy and medical channels. This illustrates how multiple, overlapping discount systems can undermine the simple expectation that cheaper biosimilars will win. Interchangeability designations, which let pharmacists substitute biosimilars without a new prescription, also vary by product and formulation, adding to complexity. Pharmacists now report that a prescription accepted by one PBM may be rejected by another because of non-covered brand selection, requiring them to check each patient's plan-preferred product before dispensing.