Rising costs, biosimilar challenges and infusion shifts

This page details therapeutic trends for autoimmune and inflammatory conditions in spring 2025, including rising medication costs, slow adoption of biosimilars, expanded ambulatory and home infusion care and notable new drug approvals.

Advancements in treatment

Autoimmune and inflammatory diseases occur when the immune system mistakenly attacks the body, causing chronic inflammation and organ damage. These conditions affect multiple systems, notably dermatology, gastroenterology and rheumatology.

• Dermatology: Conditions like psoriasis and pemphigus vulgaris lead to persistent skin inflammation and visible lesions.
• Gastroenterology: Diseases such as Crohn's and ulcerative colitis cause chronic digestive tract inflammation, resulting in severe symptoms and complications.
• Rheumatology: Disorders like rheumatoid arthritis and lupus affect joints and connective tissues, leading to pain, swelling, and disability.

Advancements in immunology have led to innovative treatments, including targeted biologics and small-molecule therapies, improving patient outcomes. Table 1 outlines the top 10 medications by disease state, market share and expected price changes.

Table 1. Top medication spend in autoimmune and inflammatory conditions

Source: Vizient pharmacy program participant data, Oct. 2023 – Sept. 2024
*Portion of spend for the NDCs making up the top 85% of Vizient pharmacy program participant spend; top 10 medications for the autoimmune and inflammatory therapeutic area comprise 23.49% of overall spend for that same period
Abbreviations: Derm = dermatology; GI = gastroenterology; Rheum = rheumatology

Table 2 shows the top 10 medications for autoimmune and inflammatory conditions with the greatest change in spend for 2024 versus 2023.

Table 2. Top 10 medications with greatest change in spend

Source: Vizient pharmacy program participant data, CY 2024 vs. CY 2023

Accelerating shift to ambulatory infusion centers and the home

Driven by cost savings, convenience and payer initiatives, autoimmune and inflammatory infusion treatments are rapidly shifting from hospital settings to lower-cost ambulatory centers and the home.

Source: Sg2 Impact of Change® Forecast highlights. Sg2 healthcare intelligence, 2024.

Cost efficiency and payer strategies

Ambulatory infusion centers (AICs) offer lower-cost infusion alternatives promoted by payers through prior authorization, tiered reimbursements, patient incentives and value-based models encouraging home infusions.

Expansion and digital integration

Health systems and infusion networks are expanding AICs and home infusion services, leveraging digital health tools, remote monitoring and AI to improve patient care and adherence.

Future outlook and challenges

AIC and home infusion will increasingly become standard as payers focus on cost efficiency, but staffing shortages, variable reimbursements and infrastructure costs may slow adoption.

Adalimumab biosimilars

Adalimumab, the reference product known as Humira, faces growing biosimilar competition as PBMs shift coverage. Despite multiple options, adoption remains slow. Figure 2 shows Hyrimoz leading the market, while patients transition to IL inhibitors like Skyrizi and Rinvoq, highlighting the impact of payer dynamics beyond pricing.

Factors contributing to the sluggish uptake of adalimumab biosimilars:

• Provider and patient hesitancy about interchangeability. The complexities of reimbursement processes further complicate the transition.
• Aggressive contracting strategies by AbbVie, the manufacturer of Humira, including rebates and discount programs, to retain market share.

The future of adalimumab biosimilar adoption will depend on several key factors:

• Broader formulary inclusion by PBMs and health systems
• Provider confidence in switching patients from the reference product to biosimilars
• Increased education around the efficacy and safety of biosimilars to address lingering concerns and shifting prescriber preferences
• Long-term real-world evidence

CVS Health boosted market share of adalimumab biosimilar Hyrimoz through its subsidiary Cordavis's partnership with Sandoz. In January 2024, CVS Caremark removed Humira from its national formularies, positioning Hyrimoz as preferred and driving rapid prescription growth (Figure 2).

Source: IQVIA

Ustekinumab biosimilars

Ustekinumab (Stelara) faces biosimilar competition, but adoption may be slow due to payer formulary delays, regulatory hurdles and uncertainty from Medicare drug price negotiations. Several factors are contributing to a cautious adoption trajectory for ustekinumab biosimilars:

• Payer formulary delays and regulatory complexities
• Medicare drug price negotiations creating uncertainty and delaying payer decisions
• Interchangeability concerns and physician hesitancy to switch stable patients
• Competition from newer IL-17 and IL-23 inhibitors with superior efficacy limiting biosimilar appeal
• Need for long-term real-world evidence to build provider confidence
• Value-based contracting and reimbursement adjustments influencing market adoption

New and noteworthy novel drug approvals

Abbreviations: SC = subcutaneous, IV = intravenous

Pipeline: Anticipated high-impact approvals

Abbreviations: SC = subcutaneous, IgA = immunoglobulin A, IV = intravenous

Vizient resources

The Vizient Pharmacy Solutions webpage contains clinical resources maintained and published by the Center for Pharmacy Excellence, including:

• Continuing Education programs
• Drug shortage mitigation strategies
• Essential Medications List
• Minute Market Insights
• Monographs and class reviews
• Side-by-side comparisons
• Therapeutic updates (FDA drug approvals)
• VerifiedRx podcasts
• Pharmacy Monitor newsletter archives