Dive Brief:A major California health plan has struck a novel deal with a drug manufacturer for a cheaper version of Humira, entirely cutting out pharmacy benefit managers controversial middlemen in the drug supply chain that typically control access to medications.As a result of the deal, Blue Shield of California will purchase a Humira biosimilar for $525 per monthly dose, significantly below the drugs net price of $2,100.The biosimilar will be available for most of BSCAs commercial members at $0 co-pay starting Jan. 1, 2025, according to the insurer, which announced the deal Tuesday.Dive Insight:Blue Shield of California, or BSCA, is one of the largest health plans in Americas most populous state, with more than 4.8 million covered lives. Its also proved more willing than others to take drastic action to lower drug costs, recently rolling out an unusual pharmacy benefits arrangement that takes functions normally performed by one PBM and divvies them up to multiple vendors instead. BSCA expects that arrangement to save hundreds of millions of dollars each year.Now, the insurer is targeting AbbVies blockbuster drug Humira as its latest bid to cut costs.Humira, which treats a variety of inflammatory conditions like arthritis and Crohns disease, is one of the best-selling drugs of all time and a peak example of how medications can be lifesaving for patients while creating an enormous financial burden on the U.S. health system.At a list price around $7,000 per dose, Humira has been massively lucrative for AbbVie. The drug has generated more than $220 billion in sales from its launch in 2002 up through last year, when it lost U.S. market exclusivity.There are now 10 Food and Drug Administration-approved biosimilars of Humira available at a significantly lower cost, yet the availability of alternatives has not significantly lowered Humiras price.BSCA spends well over $100 million annually on Humira, more than any other medication, according to a spokesperson for the insurer.Biosimilars are often out of reach for payers and their members because of how PBMs craft formularies, or the lists of drugs they cover.PBMs receive rebates from pharmaceutical manufacturers in exchange for placing their medications in a favorable position on the formulary. Generally, the pricier the drug, the larger the rebate. PBMs have been accused of prioritizing high-cost, brand-name drugs on their formularies and hesitating to adopt biosimilars as a result.Switching all Humira patients to biosimilars would save the U.S. health system up to $6 billion but PBMs would lose up to an estimated 84% of their profits from the drug, according to life sciences consultancy Iqvia.For its new biosimilar arrangement, BSCA negotiated directly with a subsidiary of German manufacturer Fresenius, with the help of Evio Pharmacy Solutions, a company owned by Blues plans including BSCA. As a result, BSCA can get a Humira biosimilar without the traditional markups created by PBMs, according to the insurer.Its the first time this type of model has been used to bring a Humira biosimilar to market, BSCA said, and yields a much lower cost than both the brand-name version of the drug and its biologic copycats.The $525 price tag for BSCA compares to $584 for a Humira biosimilar at Mark Cuban Cost Plus Drug Company, or about $1,300 for one produced by Cordavis, a manufacturing subsidiary of CVS, for example.We will no longer take part in a pharmacy system that is designed to maximize the profit of participants instead of the quality, convenience, and cost-effectiveness for consumers, BSCA CEO Paul Markovich said in a statement.BSCA is looking into applying this model to other pricey brand-name drugs, too. A number of widely prescribed drugs, including Merck & Co.s Keytruda and Amgens Enbrel, will lose their patent protection in the next few years.This is just one of many biosimilars to come, a BSCA spokesperson said.Major PBMs notably CVS Caremark, Cignas Express Scripts and UnitedHealths Optum Rx have said theyre prioritizing biosimilar access amid rising criticism for their role in driving up U.S. drug costs.Caremark, the largest PBM in the nation, launched Cordavis to produce and market biosimilars, and removed brand-name Humira from most of its major commercial formularies this spring.Similarly, Express Scripts announced it would remove Humira from its largest commercial formulary in favor of multiple biosimilars this summer. The PBM also has a subsidiary called Quallent Pharmaceuticals that markets Humira biosimilars.Optum Rx is also removing brand-name Humira from some of its preferred formularies in favor of a less expensive version starting in 2025.Much of the concern swirling around PBMs stems from the vertical integration of the three largest players. Caremark, Express Scripts and Optum Rx are all owned by massive healthcare conglomerates that also include a national health insurer and pharmacy network.Now, lawmakers are flagging additional worries about those PBMs stepping into the marketing of biosimilar and generic drugs.On Tuesday, two top Senate Democrats asked the Federal Trade Commission to investigate PBMs co-manufacturing practices, arguing that CVS and Express Scripts manufacturing subsidiaries further widen their already significant control over the pharmaceutical supply chain.The FTC sued the Big Three PBMs last month over anticompetitive concerns, including how PBMs rebating practices are allegedly inflating drug costs. '