By Patrick Wingrove and Raghav Mahobe

(Reuters) -Cigna Group’s Express Scripts pharmacy benefits unit will add three biosimilar versions of AbbVie’s blockbuster arthritis treatment Humira to its list of preferred drugs, the company said on Monday.

The biosimilars include Hyrimoz and an unbranded version of Humira from Swiss drugmaker Novartis’ Sandoz generics division, as well as German drugmaker Boehringer Ingelheim’s Cyltezo.

Sandoz had announced that its unbranded biosimilar, known chemically as adalimumab-adaz, would be priced at an 81% discount to Humira’s current list price of $6,922 per month, and Hyrimoz at a 5% discount.

Boehringer said it would launch Cyltezo at 5%-7% below the Humira list price.

Express Scripts said the biosimilars would be included as preferred brands on the its formulary or its drug reimbursement list. Pharmacy benefit managers (PBMs) act as middlemen for employers and health plans. They negotiate rebates and fees with drug manufacturers, and create lists, or formularies, of medications that are covered by insurance, and reimburse pharmacies for patients’ prescriptions.

Express did not respond to requests for comment on whether patients would have the same access to Sandoz’s lower-priced biosimilar as the much more expensive near copies of Humira on its formulary.

Robert Popovian, the chief science policy officer at patient advocacy group Global Healthy Living Foundation, said if Cigna puts Sandoz’s unbranded version on a different tier to the other biosimilars, patients might have to pay higher out-of-pocket costs for the drug or meet some additional criteria.

The drugs, which became available this month, add to U.S. competition for Humira that began in January with the launch of Amgen’s Amjevita, which is already on Express Scripts’ reimbursement list.

UnitedHealth Group’s PBM unit Optum RX announced in June that it would cover the two Humira biosimilars from Sandoz alongside Boehringer’s Cyltezo and Amgen’s Amjevita on its reimbursement list.

Unlike generic versions of pills, complex biotech drugs made from living cells cannot be exactly copied, thus the term biosimilar. They typically come with less of a discount off the branded drug than traditional generics.

Organon, Coherus BioSciences and South Korea’s Celltrion have also launched Humira biosimilars.

(Reporting by Patrick Wingrove in New York and Raghav Mahobe in Bengaluru; Editing by Shinjini Ganguli and Bill Berkrot)

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