{"title":"Increasing formulary adoption of adalimumab biosimilars and differential cost-sharing in Medicare Part D plans.","authors":"Alina S Feng, Wilson Liao","doi":"10.1080/09546634.2026.2709925","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Adalimumab was among the first biologics to face widespread biosimilar competition following US market entry of multiple adalimumab biosimilars in 2023. However, Medicare Part D formulary adoption of these products and their associated specialty-tier cost-sharing requirements remain unknown.</p><p><strong>Methods: </strong>To evaluate adalimumab biosimilar adoption and associated cost-sharing patterns across Medicare Part D formularies, Centers for Medicare & Medicaid Services (CMS) Medicare Part D Formulary and Plan Benefit Package files were analyzed. Plans were categorized as covering originator adalimumab-only, both originator and biosimilar products (dual coverage), or biosimilars-only.</p><p><strong>Results: </strong>In 2023, all Medicare Part D plans covering adalimumab listed only the originator product. By 2024, 52.5% of plans provided dual coverage, increasing to 79.9% in 2025. Biosimilar-exclusive coverage increased from 8.6% of plans in 2025 to 45.9% in 2026, while originator-only coverage declined to 0.8%. Median specialty-tier coinsurance differed according to coverage strategy. In 2026, median specialty-tier coinsurance was 33% among originator-only plans, 27% among dual-coverage plans, and 25% among biosimilar-only plans.</p><p><strong>Conclusions: </strong>Medicare Part D formularies rapidly included adalimumab biosimilars following market entry, with substantial growth in biosimilar-exclusive coverage by 2026. Specialty tier coinsurance varied by medication coverage type, suggesting that evolving formulary strategies may influence beneficiary cost-sharing requirements.</p>","PeriodicalId":94235,"journal":{"name":"The Journal of dermatological treatment","volume":"37 1","pages":"2709925"},"PeriodicalIF":3.9000,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of dermatological treatment","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/09546634.2026.2709925","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/8/4 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
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Abstract
Objectives: Adalimumab was among the first biologics to face widespread biosimilar competition following US market entry of multiple adalimumab biosimilars in 2023. However, Medicare Part D formulary adoption of these products and their associated specialty-tier cost-sharing requirements remain unknown.
Methods: To evaluate adalimumab biosimilar adoption and associated cost-sharing patterns across Medicare Part D formularies, Centers for Medicare & Medicaid Services (CMS) Medicare Part D Formulary and Plan Benefit Package files were analyzed. Plans were categorized as covering originator adalimumab-only, both originator and biosimilar products (dual coverage), or biosimilars-only.
Results: In 2023, all Medicare Part D plans covering adalimumab listed only the originator product. By 2024, 52.5% of plans provided dual coverage, increasing to 79.9% in 2025. Biosimilar-exclusive coverage increased from 8.6% of plans in 2025 to 45.9% in 2026, while originator-only coverage declined to 0.8%. Median specialty-tier coinsurance differed according to coverage strategy. In 2026, median specialty-tier coinsurance was 33% among originator-only plans, 27% among dual-coverage plans, and 25% among biosimilar-only plans.
Conclusions: Medicare Part D formularies rapidly included adalimumab biosimilars following market entry, with substantial growth in biosimilar-exclusive coverage by 2026. Specialty tier coinsurance varied by medication coverage type, suggesting that evolving formulary strategies may influence beneficiary cost-sharing requirements.
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