Zymfentra Gains Coverage in 75% of U.S. Insurance Market
Celltrion’s Zymfentra has been successfully listed in the formularies managed by 26 major U.S. pharmacy benefit managers (PBMs) and insurance companies.
This includes PBMs like Express Scripts, one of the three major PBMs. After launching Zymfentra, the world’s only subcutaneous (SC) infliximab, in the U.S. in March, Celltrion secured a formulary agreement with Express Scripts within just two weeks. By August, they had agreements with all three major PBMs, which together account for 80% coverage of the U.S. insurance market.
The U.S. insurance market is divided into private and public insurance, and agreements with PBMs are made separately for each. Celltrion has completed formulary agreements for both private and public insurance with two major PBMs, with only private insurance pending for the third PBM.
Beyond the three major PBMs, the listing for Zymfentra is progressing smoothly in both nationwide and regional PBMs and insurance companies. As a result, Zymfentra has secured coverage in 75% of the U.S. insurance market, and this could exceed 80% once private insurance agreements with the remaining PBM are finalized.
Notably, many regional insurers included Zymfentra in their formularies without separate rebate agreements, which enhances profitability. As interest continues to grow among regional insurers, Celltrion anticipates securing a majority of the U.S. insurance market coverage by the end of the year.
Celltrion aims to achieve a market share of at least 15% for Zymfentra alone by 2025, separate from its Remsima IV product (known as Inflectra in the U.S.). The company plans to leverage its insurance coverage success to rapidly accelerate sales, emphasizing Zymfentra as the only SC formulation of the infliximab, a key treatment for inflammatory bowel disease (IBD).
“Following the agreements with major PBMs like ESI, Zymfentra is being positioned as a core treatment in the U.S. IBD market through continued listings with associated regional insurers,” said Thomas Nusbickel, Chief Commercial Officer of Celltrion USA.
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