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Formulary Frontlines®

Comparative Review of RA Biologics and DMARDs Coverage Across 3 Major Health Plans

Danielle Sposato
Juliet Gallagher
05/23/2025
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As biosimilars reshape the rheumatoid arthritis (RA) treatment landscape, payers face growing pressure to balance cost containment with access. Our latest Formulary Frontlines report provides a strategic comparison of how Blue Cross Blue Shield, Cigna, and UnitedHealthcare manage coverage for biologics and DMARDs—spotlighting critical differences in tier structures, utilization management, and biosimilar integration.

Key Insights

  • Cigna prioritizes originator brands in high-cost tiers—suggesting a rebate-driven approach over biosimilar adoption
  • BCBS employs strict tiering to reinforce cost discipline and limit high-cost utilization
  • UnitedHealthcare expands biosimilar access through broader mid-tier placement, though still imposes PA and SP requirements

What You'll Gain

  • Side-by-side formulary comparisons of TNF inhibitors, IL-6 and IL-1 agents, and costimulation modulators.
  • Clarity on how formulary positioning affects pricing leverage, prescribing patterns, and member experience.
  • Actionable insights to benchmark your own formulary strategy in a shifting market.

Download the full report to benchmark your formulary strategy and stay competitive in the evolving RA biosimilar landscape.

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