Scripius is poised to make a decisive move by removing Stelara from our standard Large Employer formularies as of July 1, 2025. It will be replaced with the biosimilars Pyzchiva (manufactured by Samsung Bioepis) and Selardsi (manufactured by Teva Pharmaceuticals). These alternatives deliver a remarkable Wholesale Acquisition Cost (WAC) savings of 80%-85%, respectively, compared to Stelara1.
Clients can expect substantial savings, benefiting both members and payers.
Adopting the Stelara biosimilar
Many Pharmacy Benefits Managers (PBMs) will encourage their clients to adopt ustekinumab, a biosimilar form of Stelara. The problem for those using non-transparent PBMs is the lack of clarity—especially for plan sponsors—about how much this biosimilar actually costs or what savings it provides.
Buyer beware: Payers should question their PBM
Industry publications have reported that some payers may not be getting the deal they think they do when they move from Stelara to a biosimilar. A recent report from Biosimilars Review & Report even asks, “Does Anyone Really Know What Price It Is?”2.
The BR&R report shows just how complex the relationship is between those manufacturing ustekinumab’s biosimilars, the distributors bringing them to market, and the PBMs that provide final pricing to clients.
Ustekinumab under the lens of the big four and vertical integration
The two primary criticisms of the PBM industry have always been:
- Four companies control 70% of all PBM business in the U.S.3, and
- Lack of competition in the marketplace may create situations where payers and consumers do not receive the lowest price possible.
With this lens, payers should ask questions about their specific deal for Stelara biosimilars.
For example, one business might distribute ustekinumab (a Stelara biosimilar) to a large PBM. However, both the distributor and the PBM are ultimately operated by the same company, which also owns manufacturer operations and retail pharmacies4. This corporate structure is known as ‘vertical integration’, and these structures have been widely criticized5 because they are confusing and can lead to opaque pricing practices.
Payers who utilize a vertically integrated PBM should question the actual savings they receive when switching from Stelara to a biosimilar. For example, in one vertically integrated structure payers may receive only “46% below the full WAC of Stelara” leaving 35-40% of potential Wholesale Acquisition Cost (WAC) savings unaccounted for6.
The opportunity
Payers should understand the real opportunity of a Stelara biosimilar switch. If they find that they are not getting the right deal—or even worse, if they can’t figure out what kind of deal they’re getting—it might be best to consider other options or switch to a transparent, pass-through PBM, like Scripius. Transparent PBMs avoid the problems created by vertical integration and pass all savings directly to clients and members.
More about biosimilars and transparent pricing
Scripius has been a rapid adopter of biosimilars, including Humira alternatives like adalimumab-atto and adalimumab-bwwd, saving clients an average of $12 PMPM annually. Read about Scripius’ commitment to 100% price transparencyAdopting Biosimilars and biosimilar adoption strategy. You can contact us at GetSavingsNow@Scripius.org or message us on LinkedIn to further the discussion.
[2]https://biosimilarsrr.com/2025/04/04/quallents-questionable-ustekinumab-biosimilar-pricing-and-enbrel-price-ceiling-in-the-rockies/
[3] https://www.ama-assn.org/health-care-advocacy/access-care/pbm-market-competition-hard come#:~:text=%E2%80%9CTrends%20in%20the%20industry%20have,2
[4] https://www.drugchannels.net/2025/04/mapping-vertical-integration-of.html#:~:text=Raising%20prices%20of%20PBM%20services,plans%20versus%20Medicare%20Part%20D.
[5] https://www.ama-assn.org/health-care-advocacy/access-care/pbm-market-competition-hard-come
[6] https://biosimilarsrr.com/2025/04/04/quallents-questionable-ustekinumab-biosimilar-pricing-and-enbrel-price-ceiling-in-the-rockies/