Biosimilars for Humira 40mg (kids)

[Infinte]

Got a letter from Insurance (Aetna + CVS Caremark) that they would no longer cover Humira starting April 2024 & had advised to use Biosimilars
Here's what they are recommending as a biosimilar alternatives which they would cover:
Adalimumab-adaz
Hyrimoz
Rinvoq
Skyrizi (Sub Q)
Stelara (Sub Q)

Anybody had any experience with either one of those? Please I know for sure Stelara is of adults.

Some facts:
My son was diagnosed at age 12
He is 15 now on Humira once a week + Methotrexate once a week

Thanks.

 

[my little penguin]

Stelara is approved for PsA in kids as young as 12.
It is possible for it to be approved by insurance for teens .
My child (now adult 20 ) was 14 when he started Stelara after humira failed .
He had been on humira for 5 years plus mtx

Stelara , rinvoq (jak inhibitor ) , skyrizi are all brand name biologics and very expensive . They are not biosimilars

only
Adalimumab-adaz
Hyrimoz
Are biosimilar to humira .
In theory they should work the same as humira .
Since they are not exactly the same they may not work the same but they should be .

insurance should give the least amount of trouble for these .
Definitely talk to your child’s Gi
Teen years are the hardest to control symptoms due to chemical changes from puberty which increases inflammation.

 

[Scipio]

It's curious that they will cover Stelara or Skyrizi but not branded Humira, Stelara and Skyrizi are both sexy newer anti-IL-23 drugs and are far more expensive (based on list price) than the older Humira and Remicade anti-TNF drugs.

 

[my little penguin]

I “think” based on our experience with insurance is the list they provided is the drugs permitted on the plan .
But not necessarily ones that would be approved easily instead of brand humira .
Meaning if you showed you failed the biosimilar to humira then you would have the option to try to get Stelara /skyrizi etc approved but no guarantee.
But just because it’s on the list of drugs on their plan doesn’t mean they will approve it in place of branded humira without trying the biosimilars first .

 

[Maya142]

Theoretically, biosimilars are supposed to work as well as the original Humira. It’s a little like generics and brand name drugs - like ibuprofen and Advil. So far, we know of several kids who were made to switch from Remicade to the Inflectra biosimilar. All that I know of did well. Same with Humira - I only know one kiddo who had to switch. The biosimilar worked well except it had a preservative in it, so the shot was more painful than Humira.

In terms of Stelara, even if your insurance covers it, it seems like most kids need it more frequently than 8 weeks and that becomes a huge insurance battle.

Stelara is approved for kids with psoriasis and psoriatic arthritis. Skyrizi and Rinvoq are not approved for kids yet though I believe Skyrizi is in trials.

My daughter just tried Rinvoq and unfortunately for her, it did not work for her Crohn’s or her arthritis. We are actually re-trying Humira since she hasn’t been on it since she was a teen (roughly 8 years ago or so).

 

[Maya142]

I want to add - not all Humira biosimilars have preservatives that sting when injected in them. Only some do - many are similar to Humira and don’t.

 

[Infinte]

Thank you all for your insightful responses. We do not see the doctor for another month, but did speak to her. She believes Hyrimoz will work.
From what I have been informed insurance companies generally do not approves Stelara (for kids) until something else fails.
Either way...it's stressful that we have to switch from something that was working & start all over again being mindful of how he is reacting to new medication.

 

[Maya142]

Good luck! Hopefully it will be an uneventful transition, especially if he’s currently doing well on Humira. Remember that it’s not like a totally new drug.