First-line treatment of milder forms of psoriasis will continue to be with cheaper, topical medications. Use of more expensive, systemic therapies will be relegated to more severe psoriasis. 

Humira faces headwinds as 10 adalimumab biosimilars have launched in the past two years. Although Caremark, a major US pharmacy benefit manager, has removed Humira from its formulary, the drug continues to dominate the adalimumab market, accounting for approximately 80% of market share. Biosimilar versions of Stelara are also on the horizon.