July 2025 Clinical Recap
Jake Goll, PharmD (jake.goll@theprismhealthgroup.com) serves as the clinical consultant at Prism Health Group, where he provides end-to-end oversight of clinical strategy through in-depth data analysis, proactive consultation, and subject matter expertise.
AbbVie Biologic Portfolio Review and Biosimilar Persistence
Somehow, we’ve already passed the halfway mark of 2025 – over two years since the first Humira biosimilar entered the market and six months since the first Stelara biosimilar launch. With that, I wanted to take a moment to share a brief forensic analysis in response to some of the questions we’ve received regarding biosimilar persistence. With it still being too soon to evaluate Stelara biosimilars, this analysis will focus solely on Humira biosimilars. All insights are drawn from Prism’s book of business data.
Some frequently asked questions:
- Which patients are remaining on biosimilars post-transition?
- Who is reverting to Humira after trial of a biosimilar?
- Who is bypassing biosimilars altogether and moving directly to Rinvoq or Skyrizi – AbbVie’s primary Humira competitors.
Amjevita, the first Humira biosimilar, launched in January 2023. Since then, multiple others have entered the market, with some priced under $700 (net) for a standard 28-day supply, over 70% less than Humira’s estimated monthly net cost.
Although biosimilar utilization is increasing and Humira use is declining, reference product utilization still remains high as some PBMs slow walk formulary transitions. The table below shows the breakdown of members utilizing a biosimilar vs. brand AbbVie biologics in the first half of 2024 vs. first half of 2025.
A circulating narrative in the healthcare industry is that manufacturers are attempting to steer utilization toward alternative brand products within their portfolios, undermining biosimilar adoption and limiting savings for plan sponsors. For example, rather than transitioning from Humira to a biosimilar, members may instead be shifted to other AbbVie brands like Skyrizi or Rinvoq. While there is increased utilization of these products, the majority appears to come from biologic new starts. Only 2.9% of members with a history of a brand Humira claim in 2025 transitioned to either Rinvoq or Skyrizi.
Overall, biosimilar persistence appears strong, with most members who start or transition to a Humira biosimilar remaining on therapy. Details are outlined below:
- 2.4% of members with a brand Humira claim in 2025 had previously been on Humira, transitioned to a biosimilar, and subsequently went back to Humira.
- 1.4% of members with a brand Humira claim in 2025 had previously started on a biosimilar (new to biologic therapy) and then transitioned to brand Humira.
If there are additional topics or data points you’d like to see explored, feel free to leave a comment or message us directly. Prism publishes an annual book of business trend report, and we’re always open to incorporating new areas of interest based on client feedback.
GLP-1 Therapy: Emerging Evidence on Nutrient Deficiency Risk
A study published last month in Obesity Pillars conducted an in-depth analysis of GLP-1 side effects, focusing on nutritional deficiencies and muscle loss. The study included 461,382 adults newly prescribed GLP-1s between July 2017 and December 2021, most of whom had type 2 diabetes.
GLP-1s promote weight loss by reducing appetite and increasing satiety, but this also leads to decreased intake of essential macronutrients and micronutrients. Additionally, side effects like nausea, vomiting, diarrhea, and delayed gastric emptying may further impair nutrient absorption. Notably, individuals with obesity are already at increased risk for micronutrient deficiencies due to poor diet quality and chronic inflammation.
Key findings from the study include:
- Within 6 months of GLP-1 initiation, 13% of patients were diagnosed with a nutritional deficiency; by 12 months, this rose to 22%.
- Compared to metformin alone, patients using GLP-1s plus metformin had significantly higher rates of:
- Any nutritional deficiency or complication
- Thiamine deficiency (Vitamin B1)
- Other Vitamin B deficiency
- Vitamin D deficiency
- Nutrient deficiencies and muscle loss were more commonly diagnosed in patients who had a dietitian visit within 6 months of starting a GLP-1. This is likely due to (a) increased likelihood of referral due to symptoms and (b) routine screening by dietitians as part of a multi-disciplinary care team involved in metabolic health.
- Malnutrition can have serious consequences. A 2018 study showed that adults aged 65+ diagnosed with malnutrition had a 69% higher risk of death and significantly higher annual healthcare costs compared to well-nourished peers. This underscores another potential hidden cost of GLP-1 therapy, if not appropriately managed.
Recommended takeaways:
- Early nutritional interventions, focusing on fiber, adequate protein, and micronutrient-dense diets, may help prevent muscle loss and nutritional deficiencies, though more research is needed to confirm effectiveness.
- Nutrition counseling by a registered dietitian or nutritionist should be considered at GLP-1 initiation to support monitoring and early detection of deficiencies. Current ADA guidelines support nutritional monitoring but do not explicitly address screening protocols.
- Metformin remains an effective, first-line therapy for type 2 diabetes and poses a lower risk of nutritional deficiencies compared to GLP-1s.
Real-World Data on JAK Inhibitors Raises Cancer Risk Concerns, but Mortality Unaffected
As highlighted in AbbVie’s biologic portfolio data in the first article, Rinvoq continues to gain market share through the first half of 2025. However, new real-world evidence may temper some of that momentum. A recent registry-based study published in theAnnals of Rheumatic Diseases reported an increased cancer risk associated with Janus kinase (JAK) inhibitors, including Rinvoq, Xeljanz, and Olumiant, in patients with rheumatoid arthritis, relative to other biologic therapies.
The trial, using data from a German registry, is the first observational study to reinforce concerns raised by the randomized ORAL surveillance trial, which initially flagged cancer risk as a potential class effect of JAK inhibitors.
Mechanistically, JAK inhibitors act on the “JAK-STAT” signaling pathway to curb inflammation and immune overactivity, key drivers of joint destruction in rheumatoid arthritis. However, inhibiting this pathway may impair antitumor activity and healthy cell-death, theoretically allowing for tumor progression.
The study found a statistically significant, though modest, increase in cancer incidence compared to conventional biologic DMARDs such as Humira or Rituxan. Researchers estimated that for every 368 patients treated with a JAK inhibitor, one additional case of cancer would occur. Interestingly, the elevated cancer risk was only observed after 16 months of continuous therapy; no difference was seen in the early treatment period.
Despite these findings, researchers do not recommend avoiding JAK inhibitors outright. Overall cancer rates remain low, and the study found no increase in all-cause mortality. Additionally, JAK inhibitors offer advantages in the form of oral dosing and a faster onset of action compared to TNF inhibitors, which may make them a suitable choice for certain patients. Prescribers may increasingly weigh competing risks when choosing between advanced therapies, especially for patients expected to require long-term treatment.
More Manufacturers Join the Pharm to Table Space
In 2024, Eli Lilly and Novo Nordisk disrupted the direct-to-patient (DTP) market, often referred to as “pharm to table,” by offering discounted prices on their weight-loss GLP-1 products, Zepbound and Wegovy, through their manufacturer websites (Lilly Direct and NovoCare, respectively).
This past month, Bristol Myers Squibb (BMS) and Roche announced plans to enter the direct-to-patient space by providing select brand-name medications at discounted prices when purchased directly.
Bristol Myers Squibb
BMS will begin offering Eliquis directly to patients through its “Eliquis 360 Support” program starting September 8, 2025. The program will provide Eliquis to cash-paying patients at “more than 40 percent off” the current list price. With a list price of $615 per month, this discount equates to approximately $369 per month. The current estimated commercial rebate for Eliquis is also around 40 percent, meaning the manufacturer’s direct price aligns with the net cost PBMs typically achieve after rebate. The greatest value of Eliquis 360 Support will likely be realized by members enrolled in high-deductible health plans (HDHPs), who often do not receive the benefit of low copays or manufacturer rebates at the point of sale.
Roche
Roche has announced that it is evaluating direct-to-patient drug sales in the US for multiple sclerosis, ophthalmic, and oncology medications. While specific products and pricing have not yet been disclosed, Roche’s CEO stated the move could cut drug prices by up to 50 percent through direct sales. Potential candidates for inclusion include Ocrevus (MS), Vabysmo, Avastin, Lucentis, and Susvimo (ophthalmic), along with 19 oncology medications currently listed on Roche’s website.
Cost Impact Considerations
The broader cost impact of direct-to-patient programs remains uncertain. Weight-loss drugs like Zepbound and Wegovy are well-suited for this approach because many health plans do not cover them, making direct sales a viable route for patients seeking lower prices.
For other therapies such as Eliquis, MS drugs, ophthalmology treatments, and oncology medications, most insured patients already have adequate coverage under traditional pharmacy benefits. Even with an outside-the-PBM discount, direct pricing is often higher than the typical copay a patient would pay through their plan. Additionally, PBMs frequently leverage manufacturer assistance programs on specialty drugs, which can further lower patient costs through traditional channels. From a plan sponsor perspective, direct-to-patient models may not provide meaningful savings unless manufacturers are willing to undercut the net cost achieved after rebates and copay assistance are factored in.
