Waltz Health and Fresenius Kabi Take Biosimilars Direct to Employers — Bypassing Traditional PBM Rebates

Direct contracting is moving deeper into specialty pharmacy.

On September 29, Waltz Health and Fresenius Kabi announced an agreement that gives employers and other plan sponsors direct access to three Fresenius Kabi biosimilars through Waltz Connect.

The initial portfolio includes:

• adalimumab-aacf, a biosimilar to Humira;
• Otulfi, a biosimilar to Stelara; and
• Tyenne, a biosimilar to Actemra.

The structure is more interesting than the product list.

Instead of relying on the conventional specialty-drug model built around wholesaler distribution and rebate-driven PBM economics, participating employers and plan sponsors can access the drugs at a defined per-unit price plus Waltz Health's disclosed flat fee.

That makes this a useful example of direct contracting expanding from healthcare services into high-cost specialty drugs.

A different specialty-pharmacy purchasing model

Specialty drugs are among the largest and fastest-growing cost categories for self-funded employers.

Traditional purchasing can involve manufacturers, wholesalers, specialty pharmacies, PBMs, rebates, administrative fees, and other intermediaries before the employer ultimately sees its net cost.

The Waltz-Fresenius Kabi model is designed to simplify that chain.

Under the arrangement:

• Fresenius Kabi provides the biosimilars;
• Waltz Connect provides eligibility and pricing infrastructure;
• employers and plan sponsors receive defined product pricing;
• Waltz charges a disclosed flat fee; and
• an EVERSANA-operated specialty pharmacy handles fulfillment and direct-to-home delivery.

The companies position the structure as an alternative to traditional wholesaler distribution and rebate-driven PBM channels.

Why biosimilars make this especially interesting

Biosimilars are supposed to introduce competition into categories dominated by expensive biologic drugs.

But simply having a lower-cost biosimilar available does not guarantee that a self-funded employer captures the economic benefit.

Formulary incentives, rebates, distribution arrangements, and PBM contracting can all influence which drug is used and what the employer ultimately pays.

A direct purchasing structure changes that equation.

Instead of negotiating around a large list price and downstream rebates, the employer can evaluate a more explicit acquisition price and administrative fee.

That does not automatically mean the direct model will produce lower total costs in every case. Waltz and Fresenius Kabi have not disclosed employer-specific savings results from this new arrangement.

But it makes the economics easier for a plan sponsor to evaluate.

Direct contracting is moving into pharmacy carve-outs

This is part of a broader shift.

Employers do not necessarily need to replace their entire pharmacy benefit to change the economics of a high-cost category.

They can increasingly carve out specific products or therapeutic areas.

Waltz has already applied a direct-access model to anti-obesity GLP-1 medications. Adding specialty biosimilars extends the approach into categories including rheumatology, dermatology, and gastroenterology.

That creates a potentially important path for employer direct contracting:

carve out the categories where traditional channel economics are most difficult to justify, while leaving the rest of the pharmacy benefit intact.

If more manufacturers participate, direct specialty-drug contracting could begin to resemble the employer centers-of-excellence market: targeted alternatives built around expensive, highly concentrated areas of spend.

What to watch next

The important questions are now economic and operational:

• which employers adopt the model;
• how the direct per-unit price compares with employers' existing net specialty-drug costs;
• whether utilization shifts toward the biosimilars;
• whether additional manufacturers join Waltz Connect;
• whether the model expands into additional therapeutic categories; and
• whether employers begin systematically carving specialty pharmacy away from incumbent PBMs.

The announcement does not yet establish realized savings.

But it does establish another direct purchasing route for self-funded plan sponsors in one of healthcare's highest-cost categories.

Follow specialty carve-outs and other employer direct-contracting arrangements in the Direct Contract Deal Tracker.

Source

• Waltz Health and Fresenius Kabi — September 29, 2026 announcement