- The Real Monthly Cost of Arthritis Medication
- Megan Koezler, 21, Student
- Net Monthly Out-of-Pocket Tab: $25
- Regan Reynolds, 34, Operations Manager
- Net Monthly Out-of-Pocket Tab: $116
- Kat Macfarlane, 35, Law Professor
- Net Monthly Out-of-Pocket Tab: $200 or Higher
- Julie Wiles, 55, Client Relationship Manager
- Net Monthly Out-of-Pocket Tab: $185
- Enbrel Cost Information
- Side Effects Of Enbrel
- How Enbrel Works
- Generic Alternatives
- How can I save money on Humira if there’s no generic available?
- What is Humira?
- How can I save money on Humira?
- Is generic Humira available?
- Can I order Humira from international online pharmacies?
- Bringing Humira (Its Price) Down a Peg
- Why is Humira so Expensive?
- Introducing Humira
- Humira is the world’s top-selling drug.
- But why is Humira so expensive?
- What is the FDA ruling on Humira?
- What factors affect the price?
- Humira Coupons
- Why The U.S. Remains The World’s Most Expensive Market For ‘Biologic’ Drugs
- The most expensive drugs of 2019
- 1. Afinitor
- 2. Humira
- 3. Enbrel
- 4. Xeljanz
- 5. Forteo
- 6. Glatiramer Acetate Injection
- 7. Norditropin Injection
- 8. Stribild
- 9. Atripla
- 10. Biktarvy
- So what’s causing the high prices?
- How SingleCare can help
The Real Monthly Cost of Arthritis Medication
To best control her RA, Julie Wiles maintains a healthy diet (no soda, no added sugar, no alcohol).
Most Americans would agree: The cost of medicine can break the bank.
If you’re living with a chronic condition like arthritis, the challenge is even greater. First, you have to find the best medication for you, whatever the cost, and then you have to pay for it — or get it paid for — without putting a major dent in your budget or lifestyle.
The six men and women here are living with arthritis and have managed to control their medication costs in creative ways. And while they’ve found avenues to save money, in some cases the solutions are not without sacrifice or effort. Some switched to a less expensive, less effective arthritis medication. Others made lifestyle changes that helped them reduce their need for medications. Here are their stories and their smart, inspiring tips.
Megan Koezler, 21, Student
Net Monthly Out-of-Pocket Tab: $25
Megan Koezler, a senior at Central Michigan University in Mount Pleasant, was just 15 years old when she was diagnosed with juvenile rheumatoid arthritis, now called juvenile idiopathic arthritis. These days, Koezler feels lucky to be able to stay on her parents’ insurance and maintain low co-pays.
“I spend about $25 a month ,” says Koezler. That total is largely because she found out about co-pay cards from her pharmacy. “You sign up online and they’ll cover a certain amount per sale or per year,” she says. The maker of the drug provides the co-pay cards. (Go to a specific pharmaceutical company’s website for information.) Other organizations, such as the Patient Advocate Foundation, also offer co-pay relief.
Her best tip: Persistence pays off when seeking financial help. She was on the telephone for an hour getting the co-pay card, but it was time well spent, she says.
Regan Reynolds, 34, Operations Manager
Net Monthly Out-of-Pocket Tab: $116
In 2013, Regan Reynolds of Raleigh, North Carolina, was diagnosed with ankylosing spondylitis four years after doctors initially suspected she had an arthritic condition.
Right now, Reynolds takes Humira (adalimumab), which costs her $64 a month. Previously, it was just $5 a month because she had a co-pay assistance card from the drug maker. Without any assistance, her Humira cost would be $6,600. She also takes Cymbalta (duloxetine), often prescribed for arthritic pain, and has a $40 co-pay. In addition, as needed, she takes the pain reliever Ultram (tramadol), which has a $12 co-pay.
Her best tip: Reynolds managed to scale down the amount of pain medication she needs by focusing on lifestyle. For example, she stays away from foods that may contribute to inflammation, such as gluten and vegetables like tomatoes and green peppers. Exercise is key, too. “I’m a firm believer in the ‘motion is lotion’ mantra with ankylosing spondylitis. I do my best to just keep moving,” she says. She also walks two or more miles every day, and fits in other workouts, too. These lifestyle changes have greatly helped lower her need for pain medicines, she says.
Kat Macfarlane, 35, Law Professor
Net Monthly Out-of-Pocket Tab: $200 or Higher
Now a law professor at the University of Idaho in Moscow, Kat Macfarlane was diagnosed with juvenile rheumatoid arthritis at age 1. Like many with arthritic conditions, Macfarlane has a co-existing condition, iritis, a painful eye inflammation that can lead to serious eye problems, including vision loss.
She’s on Enbrel (etanercept), with a $40 co-pay, and methotrexate ($120 co-pay), and she spends another $40 on over-the-counter pain medicines. That doesn’t include weekly eye doctor appointments to manage complications of her iritis.
“I have excellent insurance,” she says, yet she still faces ongoing out-of-pocket medication expenses.
Her best tips: In addition to taking advantage of health savings accounts, she highly recommends ”hanging out” on a website such as CreakyJoints, where you can pick up tips. Members of the site answer questions and offer advice based on their experience with certain medications. She’s been on four biologics, for instance, and finally found one that works, with guidance from others with similar health issues.
Julie Wiles, 55, Client Relationship Manager
Net Monthly Out-of-Pocket Tab: $185
Julie Wiles of The Woodlands, Texas, was diagnosed with RA about five years ago. Life was good when she was on Enbrel (etanercept) for about eight months. It made her ”a whole new person,” she recalls. Unfortunately, the drug maker’s assistance program she was on ended, and her insurance did not cover the cost.
“Enbrel was approximately $1,200 per injection, and I was taking one injection a week,” says Wiles. She found assistance programs that would cover the first $4,000, but then she knew she’d still have a lot to pay out of pocket. So she went on methotrexate instead, which she now takes weekly. She’s also on Plaquenil (hydroxychloroquine) twice a day, folic acid (to lower the risk of skin and mucous membrane problems linked with methotrexate use), and a medicine for anemia (which can occur with inflammatory diseases). “On medications right now, I am spending about $185 a month,” she says. Wiles has searched for different insurance plans, but better coverage comes at a premium cost.
Her best tip: While she’d rather be back on Enbrel because it made her feel so good, she’s now focused on improving her lifestyle for better control of her RA. “I eat an extremely clean diet,” she says. For her, that means no alcohol, no added sugars, and no soda. She also exercises regularly and maintains a healthy weight.
Enbrel is used (sometimes in combination with methotrexate or another immunosuppressant) to treat psoriasis and certain types of arthritis. These conditions are the result of an overactive immune system, which causes the body to attack its own cells even though they are healthy. These attacks on healthy cells are the cause the inflammation on the skin and in the joints. Enbrel treats autoimmune diseases, but it does not cure them.
Stopping the medication usually causes the symptoms to reappear after a month. For many patients, the Enbrel price, even with all the risks, is less important than the relief the medicine brings. Patients take the medicine through injections.
Enbrel Cost Information
Many patients have discovered that the Enbrel prices can be almost as crippling as the arthritis the medicine is supposed to treat. A purchase of 4 vials may cost as much as $1200 or more, although the cost may be reimbursed by your health insurance. However, if you buy from abroad because the Enbrel cost there is lower, then it is possible that your insurance may not cover the purchase. Discuss the matter first with your insurance carrier. US citizens who also buy from abroad a 3-month supply at the most will also not be prosecuted by the US government.
Because the Enbrel price is so high (and because there’s too much risk if you get an inferior product), you need to verify that you are buying from a legitimate source. If you buy online, make sure that the online pharmacy is totally legit. The total Enbrel cost may reach $20K a year.
Side Effects Of Enbrel
You may experience some swelling, itching, redness, or pain a day or two after you’ve received the injection. These side effects should clear up in three to five days. You may experience some injection site reactions, but those should lessen in a month. You may also experience some headaches. If any of these side effects persist, you should inform your doctor as soon as possible.Not everyone experiences side effects, and many do not experience any at all. Nonetheless, the following side effects have been reported:
- Allergic reactions.
- Asthma or shortness of breath.
- Bacterial, viral or fungal infections, which may sometimes be serious.
- Bleeding from the gut.
- Blood clot in a blood vessel (also known as pulmonary embolism or deep vein thrombosis).
- Chest pain.
- Lower levels of red blood cells, white blood cells or platelets in the blood.
- Increased or decreased blood pressure.
- Inflammation of the pancreas (pancreatitis).
- Kidney problems.
- Nerve disorders.
- New or worsening heart failure.
- Pins and needles or numb sensations.
Enbrel may not work properly, or the risk of side effects may be increased, when you use Enbrel while also taking other medications. Medicines and products that may interact with Enbrel include:
- Live vaccines (such as measles, mumps, polio, rubella, typhoid, varicella, yellow fever),
- Interleukin-1 blockers (such as anakinra, canakinumab, rilonacept),
- Other medications for autoimmune disease. These may include azathioprine, cyclophosphamide, and tofacitinib.
This list is not complete, so it is necessary for you to inform you doctor about any current medications you are currently taking before you take Enbrel. You should also refrain from taking any medications or supplements without discussing the matter with your doctor beforehand.
How Enbrel Works
Enbrel works by blocking the immune system so that it does not attack healthy cells. This means that you should avoid taking any vaccines while on Enbrel, and you should also avoid people who have recently taken vaccines. You should avoid people with infections as well. Your doctor must be informed about your medical history, especially if you have had a recurring infection in the past such as TB or Hepatitis-B. Your doctor should also be aware of any blood disorders like anemia or leukemia, heart failure, diabetes, cancer, a weakened bone marrow, seizures, any nervous system disorders like multiple sclerosis, alcoholic hepatitis, or vasculitis and other blood vessel conditions.
If you are doing the injections yourself at home, you need to know how to do this properly. You may have to mix the Enbrel with a diluent, and you also need to know how to mix and store them properly. Do not inject into tender, bruised, or hard skin, and do not inject into the same place twice in a row. If you miss a scheduled dose, call your doctor. If you overdose, get immediate medical attention.If you are in any way unsure, arrange to have the injections done in your doctor’s office.
While there are currently no generic alternatives to Enbrel (Etanercept), in India a similar compound to Etanercept is currently being introduced as Etacept. Another drug called Pegsunercept is also a TNF receptor like Enbrel and is also being developed as a treatment for rheumatoid arthritis.
I have been talking to two people using the drug Enbrel who were shocked and disappointed to learn how expensive Enbrel will be when they get on Medicare and sign up for Part D drug coverage.
ENBREL is a prescription medicine that can be self-injected. It is used to treat moderate to severe rheumatoid arthritis (RA), adult chronic moderate to severe plaque psoriasis, and other inflammatory diseases. Enbrel is expensive and, under Medicare Part D, it is considered a “specialty drug”. That means the co-pay is 33% – and a person will go into the coverage gap/donut hole very quickly.
Enbrel cost with Part D
To find a Part D plan for clients, I put their prescriptions into the Medicare.gov Plan Finder. On every plan, Enbrel comes in at a retail price of $2,900 per month.
The Plan Finder shows that a person will go into the donut hole/coverage gap in month 2 and into the catastrophic stage in month 3. That means my clients would spend over $2,800 in the first three months and then they get big relief when they pay only 5% of the cost in the catastrophic stage.
But here’s the rub. Both of my client’s have had employer coverage and their co-pay has been around $10 for Enbrel. Once they stop working and get on Medicare, their cost will be over $4,400! Their employer coverage doesn’t have a donut hole and, according to one client, the actual cost of Enrbrel is around $600 on his employer plan.
So why is the retail cost to Part D so high? The law that created Part D says only insurance companies can negotiate Part D drug prices with pharmaceutical companies. The government is forbidden to negotiate, or set prices. But Medicare is actually paying the bill for Part D plans!!
Here is what came up in Medicare.gov Plan Finder. There are 29 Part D plans offered in Arizona.
The costs on each sheet are a bit different because one is for one client and the other is for the other client – and they are two different Part D plans.
It’s a difficult choice.
“It does give you your life back,” she said of the drug. “I literally couldn’t go away from the house or very far from a bathroom, 20, 25 times in the bathroom all day long, I can’t imagine living like that,” she said, adding, “I was becoming a hermit because I was so sick.”
Humira, which accounted for nearly two-thirds of AbbVie’s $25.6 billion in revenue in 2016, was not simple to develop. It is among a new class of drugs known as biologics, which are made from living cells rather than synthetic chemicals. The industry has argued that high American prices are needed to fund drug development, but a 2016 study published by the Journal of the American Medical Association found “no evidence of an association between research and development costs and prices; rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear.”
Competitive pressures have been muted. Copies of biologic drugs, known as biosimilars, are not as easy to produce as normal generic drugs, and AbbVie’s aggressive patent strategy has allowed it to further push off rivals. While there are name brand competitors to Humira, they are not exactly alike, complicating efforts by doctors or insurers to switch a patient from one drug to another.
Looking at the international picture tells its own story about drug costs. A prefilled carton with two syringes costs $2,669 in the United States, compared with $1,362 in Britain, $822 in Switzerland and $552 in South Africa, according to a 2015 report from the International Federation of Health Plans.
“You’ve got the largest market for pharmaceuticals, which has the highest prices,” said Christopher Raymond, senior biotech analyst at Piper Jaffray. “That doesn’t make any sense.”
But it is typical. Other countries have single-payer systems, like Britain’s National Health Service, that negotiate with drug companies or governments that exert price controls.
AbbVie has put some of its earnings to work lobbying against efforts at price controls in the United States, recently in California. The industry also successfully lobbied in 2006 to bar Medicare from negotiating over drug prices. While President Trump once talked about taking action on drug prices, his administration did not follow through in the health care debate last year.
Here is a story about how the same drug is sold in two countries. In one country, patients can be on the hook for hundreds or thousands of dollars a month. In another, it costs the patient less than a night at the movies.
Humira is a drug used to treat inflammatory conditions like rheumatoid arthritis and Crohn’s disease, helping patients ease pain from their inflamed joints or the painful sores caused by plaque psoriasis. It’s also the best-selling prescription drug in the world with over $18 billion in sales in 2017. In the U.S., the cost per patient per year is $38,000 after rebates, according to The New York Times. Without rebates, its cost is around $60,000. How much the patient pays for the drug depends on their insurance plan.
But high drug prices raise prices for everyone: insurers, patients, and the government. And with co-pays and deductibles, patients taking Humira could easily spend hundreds or thousands of dollars a year. Patients for Affordable Drugs, a non-profit advocating for lower drug prices, wrote in a letter to the Federal Trade Commission earlier this year that one patient, 76-year-old Sue Lee of Kentucky, told them: “Since retiring in 2017, I had to stop taking Humira because most of the year it was costing me $5,000 a month.” Others, even with what we think of as “good” insurance, shell out thousands, too: One patient told the Times this year that she “held off buying her latest dose because her insurer had changed” to avoid shelling out $1,200 twice that year.
According to a transcript of congressional testimony, Joanna Hiatt Kim, the vice president of payment policy at the American Hospital Association, said “ AbbVie’s almost 10% price hike to Humira is expected to increase healthcare costs in this nation by a billion dollars in 2018 alone.” One billion dollars in healthcare costs in the U.S., from a price increase on one drug. The price rose by 100 percent overall between 2012 and 2018. (Of course, drug sales in the U.S. are also juiced by factors other than high prices: AbbVie is currently embroiled in a lawsuit with the California Department of Insurance for allegedly engaging “in a far-reaching scheme including cash, meals, drinks, gifts, trips and patient referrals” to “induce and reward Humira prescriptions” from doctors, according to Reuters.)
Then, there is the United Kingdom. The National Health Service just announced that it had reached deals to sell “biosimilar” versions of Humira, saving NHS hospitals £300 million, or about $384 million—“roughly three-quarters of the amount they currently spend.” A “biosimilar” is like a generic drug but for “biologics” like Humira, meaning it’s made with living cells, which make it harder to copy than regular old chemical drugs.
Why is Britain saving all this money on biosimilars and the U.S. isn’t? How come American patients aren’t getting the relief of cheaper versions of this exorbitantly-priced drug? Because of “a formidable wall of patents” built up by AbbVie in the U.S., protecting its monopoly position in the American market. Although its original patent expired in 2016, AbbVie has secured more than 100 additional patents covering things like the drug’s manufacturing process to prevent cheaper biosimilars from coming to market. Those patents won’t expire until the 2020s and 2030s. AbbVie reached deals with other drug makers—Amgen, Samsung Bioepis, Novartis, and Mylan—to keep biosimilars off the U.S. market until 2023. That means five more years of outrageous costs, with patients choosing between food and the drug that lets them walk without agony.
Britain and Europe don’t allow this sort of bullshit, which is why biosimilars for Humira hit the market this year. Five different versions of the drug are approved in Europe. And the NHS was able to make the “biggest saving in NHS history from a single drug negotiation,” according to the Guardian. Simon Stevens, the CEO of the NHS, made this point himself, telling the paper the savings are “another example of how the smarter approach to biosimilar medicines in the UK and Europe gives patients and taxpayers a much better deal than they get in the United States.”
Even before this big deal, the drug already cost less there—according to the Times, a dose “costs $2,669 in the United States, compared with $1,362 in Britain.” The NHS issued a briefing in March saying it spent $469 million on Humira to treat 57,000 patients in 2016 and 2017.
AbbVie charges more in the U.S. because they can get away with it, because the government lets them file bullshit patents to extend their monopoly over a drug they currently sell for $18 billion per year. They charge less in other countries because they can’t get away with it. Humira does not cost $60,000 to make or sell. It costs that much because AbbVie wants to make the biggest profit they can.
The example of other countries shows it does not have to be this way. There’s no reason for Congress not to immediately pass a law to prevent this. The only reason is if policymakers find it particularly important to protect the ability of pharmaceutical companies to make billions of dollars in profit, at the expense of patients. Apparently, they do.
Correction: This story originally misattributed a quote by Joanna Hiatt Kim to the CEO of the Alliance for Health Policy, which is a nonpartisan organization.
How can I save money on Humira if there’s no generic available?
Answered by Gabriel Levitt, MA | Posted December 28, 2018
Humira is a brand-name medication without a generic currently available in the U.S.
Since there is no generic competition, the manufacturer, AbbVie, is able to charge the highest price they believe American consumers will pay. Currently, a month supply of Humira can cost around $5,500 without insurance at your local U.S. pharmacy.
What is Humira?
Humira (Adalimumab Injection) is used alone or with other medications to help alleviate the symptoms of certain disorders, such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis, ankylosing spondylitis, often referred to as autoimmune diseases, in which healthy parts of the body are attacked by the immune system. These attacks cause swelling, pain, and damage. Humira works by blocking the action of tumor necrosis factor (TNF), a substance in the body that causes inflammation.
How can I save money on Humira?
1. PharmacyChecker offers discount cards for use at your local pharmacy. To search discount cards available to print and use at your local U.S. pharmacy, scroll to the bottom of the Humira price page and enter your ZIP Code to find the discounts in your area. You should be able to save around 10% by using the PharmacyChecker discount card.
When you choose a pharmacy, click the big purple price button. Then, click “Print This Card” and you are all set to obtain your discount at the pharmacy of your choice.
2. PharmacyChecker.com also offers a search tool for patient assistance programs. Many pharmaceutical companies offer aid with the cost of medications through patient assistance programs.
Humira Patient Assistance Program
3. Ask your healthcare provider for an alternative prescription used for the same indication as Humira that your insurance plan may cover or be less expensive.
Is generic Humira available?
There is currently no generic version of Humira available in the U.S. or at verified international online pharmacies.
Humira was approved for sale in the U.S. on December 31, 2002. The patent on Humira’s main molecule expired in 2016, but some experts don’t expect a biosimilar until possibly 2023 because AbbVie, the company behind Humira, has recently gathered more than seventy newer patents that cover formulations of the drug, manufacturing methods and use for specific diseases.
Humira is a biologic medication, which means it was created from living cells. This makes it very difficult to replicate exactly and protects Humira even more from generic competition. The FDA has urged competitors to create biosimilars in an effort to help decrease the cost of expensive biologics drugs. However, unlike a generic drug, biosimilars are not interchangeable with the original brand drugs and are still expensive.
Amgen has created a Biosimilar Humira, called Amjevita, and it has been approved in the U.S. It is expected to be available for sale in the U.S. market on January 31, 2023.
Can I order Humira from international online pharmacies?
The cost of a year supply of Humira sold in Canada is $20,186.
Humira is a temperature-sensitive medication and requires cold chain management during shipment. To best guarantee safe shipment, pharmacies in the PharmacyChecker Verification Program must ensure that shipments of Humira are not exposed to temperatures below 2 degrees or above 8 degrees Celsius.
There are currently no PharmacyChecker-verified pharmacies shipping refrigerated products internationally to patients in the U.S. We hope Canadian pharmacies will supply refrigerated medications, such as Humira, to U.S. customers with a valid prescription in the near future.
Updated January 28, 2020
Bringing Humira (Its Price) Down a Peg
Many rheumatoid arthritis sufferers are getting relief from their pain with Humira, but it’s likely to take until 2023 until they get any relief from the hefty price for their medication.
Adalimumab, sold under the brand name Humira, is the best-selling drug by revenue worldwide, and manufacturer AbbVie has worked hard to fend off competition from others who want a piece of the pie. Sales topped $18 billion in 2017, a 14% jump over the previous year. According to AbbVie’s 2017 annual report, Humira accounted for 65% of the company’s net revenues that year. Things haven’t changed much since.
AbbVie 2018 third-quarter revenues, by product
Percentages do not add up to 100% because of rounding
Competition is waiting in the wings, although it stands to be quite a wait before Humira has biosimilars nipping at its heels. The FDA has approved three Humira biosimilars: Sandoz’s biosimilar Hyrimoz (adalimumab-adaz), Boehringer Ingelheim’s Cyltezo (adalimumab-adbm), and Amgen’s Amjevita (adalimumab-atto). But because of patent disputes, none of them are expected to be on the market until 2023.
Of course, the Humira biosimilars are not alone in facing a tortuous obstacle course of patent and other challenges even after they get the FDA’s stamp of approval. The FDA has approved 16 biosimilars. Only six are actually for sale.
“Brand-name biologics have really abused the patent process” in order to keep competitors at bay, says Greg Gierer, senior vice president for at AHIP.
It is a completely different situation in Europe. Humira’s patent expired there in October. Competitors immediately rushed in and launched biosimilars—in some countries, with steeply discounted prices.
Humira treats rheumatoid arthritis and other inflammatory conditions, such as psoriasis and Crohn’s disease, by blocking an immune system protein called tumor necrosis factor–alpha (TNF-α). Some people produce too much TNF-α, causing inflammation. By binding to the TNF-α molecules and blocking them from attacking healthy cells, it helps to reduce the damage caused by an overproduction of TNF-α.
The FDA approved Humira in 2002, and it was on the market the next year. Patients typically self-administer a 40-milligram injection every other week.
The use of TNF-α inhibitors and biologics, more generally, to treat RA has been groundbreaking. “You rarely see anyone seriously disfigured. Biologics have transformed lives for so many people,” says Sheila Frame, vice president and head of biopharmaceuticals for North America for Sandoz. Humira has showed staying power. One long-term study of patients on the drug found that a majority of patients who were on adalimumab for one year, five years, and eight years were in remission or classified as having “low disease activity”—a common measure for gauging RA.
But as with so many of the biologics, Humira’s clinical benefits have been overshadowed lately by alarm—and arguments—about its price. Citing information from SSR Health, a health information company, the New York Times reported early last year that the price of Humira has doubled, from about $19,000 per patient per year after rebates in 2012 to more than $38,000. The Wall Street Journal reported earlier this month that AbbVie had raised the price of the drug by 6.2% at the beginning of this year. U.S. drugmakers say list prices can be misleading and that much of the money gets siphoned as rebates to middlemen.
When Humira’s patent expired in October in Europe, Novartis, Mylan, Biogen, and Amgen immediately began selling their biosimilar versions of the drug. Soon afterward, AbbVie lowered its projections for 2019 overseas sales by 26% to 27%. In a conference call with analysts, CEO Richard Gonzalez said the company had seen discounting of between 10% and 80%, with the greatest discount in Scandinavian countries, according to media reports. “The discounting has been on the higher end of the planning scenarios that we had laid out.”
While Gonzalez predicted discounting would moderate in the future, Geoffrey Porges, an analyst with Leerink Partners, a Boston investment bank specializing in the health care sector, told Reuters, “We would expect erosion to intensify in 2020, not slow.” That might be a dark cloud on the horizon for AbbVie and its Humira-infused revenues, but it’s good news for payers and patients.
Meanwhile, the state of California has sued AbbVie, alleging it gave illegal kickbacks, including cash, meals, and gifts, to providers to prescribe Humira. The company has denied the allegations.
Kent Kwasind Huston, MD, an American College of Rheumatology board member who is on staff at St. Luke’s Hospital in Kansas City, says cost will be the main factor that could induce physicians to switch patients to biosimilars.
“Hopefully, as more biosimilars enter the market and physician experience in using these drugs grows, the overall cost of biologic medications will decrease,” says Huston. “So far, the introduction of biosimilars in rheumatology has been a slow process. The cost savings has been underwhelming to date but there is hope that this will change as more biosimilars become available in the future.”
Right now, patient access to high-priced biologics like Humira has been limited by insurance coverage and the patient’s financial situation, he says.
Gierer, of AHIP, hopes prices will fall as biosimilars become more widely available, comparing the situation to generic drugs. Initially, prices didn’t come down much with generics, but as more entered the market, prices began to decline. “I think that’s the real formula for success.”
Susan Ladika is an independent journalist in Tampa, Fla., who covers health care and other issues.
Why is Humira so Expensive?
Humira is used to relieve pain and reduce inflammation in those struggling with autoimmune diseases. It is also known as Adalimumab.
It is a biologic drug which is manufactured using protein antibodies from a living organism. Humira is usually taken at home through a pen device or syringe.
Humira is the world’s top-selling drug.
Although it is beneficial to many struggling with diseases including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, and psoriasis, it is expensive to buy.
The cost of medicine really can break the bank. Without insurance, Humira costs between $1800 and $2400 each month. It is advised to look into co-pay cards at your local pharmacy to find a way around some of the expense – as it can otherwise prove very costly in the long run.
But why is Humira so expensive?
The complexity of Humira makes it such a costly drug. Proteins are produced for the medicine using DNA technology – a manipulation of genetic material. Unlike medication that is synthetically manufactured, biologics are almost impossible to replicate, which means a lot of time goes into creating Humira.
Because of this Humira cannot be marketed as genetic equivalents which proves difficult for the consumer looking for a generic version of the drug to become available.
What is the FDA ruling on Humira?
Now that the FDA has changed the rulings under the classification of Biosimilars, Humira can now be categorized as a brand new biologic which means it is subject to the same research, development and testing requirements which rules out any potential cost savings that would be passed on to the consumer.
Manufacturers cannot bypass the FDA requirements, so there is now no way around making the drug cheaper. Pharmaceutical companies which own the existing patent rights have picked up on this and now invest huge amounts of money to battle against the manufacturing of Humira and other biosimilars.
The Food and Drug Administration has been slow to roll out rules to regulate cheaper alternatives. The price of Humira has always been high, however drug companies are slowly hiking the price up in increments, too. Many in need of the drug rely on Humira coupons and insurance now to be able to pay for even the smallest of doses.
What factors affect the price?
The industry has tried to argue that more money is needed to fund the development of the drug. Abbvie, one manufacturer, claims it costs more than $2.5 billion to research and develop just one prescription, however, others argue that drugs are priced primarily on the basis of what the market will bear.
Another way those struggling to pay for the drug have coped is through lifestyle choices. Many have found that changing their diet and moving more has led to reduced pain and inflammation without taking Humira, which saves a huge amount of money.
Patient assisting programs are another way to access the pharmaceutical drug cheaper through Humira coupons. You must be able to prove your financial situation to access this program and reap the benefits.
Why The U.S. Remains The World’s Most Expensive Market For ‘Biologic’ Drugs
Europeans have found the secret to making some of the world’s costliest medicines much more affordable, as much as 80 percent cheaper than in the U.S.
Governments in Europe have compelled drugmakers to bend on prices and have thrown open the market for so-called biosimilars, which are cheaper copies of biologic drugs made from living organisms. The brand-name products — ranging from Humira for rheumatoid arthritis to Avastin for cancer — are high-priced drugs that account for 40 percent of U.S. pharmaceutical sales.
European patients can choose from dozens of biosimilars, 50 in all, which have stoked competition and driven prices lower. Europe approved the growth hormone Omnitrope as its first biosimilar in 2006, but the U.S. didn’t follow suit until 2015 with cancer-treatment drug Zarxio.
Now, the U.S. government stops short of negotiating and drugmakers with brand-name biologics have used a variety of strategies — from special contracting deals to overlapping patents known as “patent thickets”— to block copycat versions of their drugs from entering the U.S. or gaining market share.
As a result, only six biosimilars are available for U.S. consumers.
European countries don’t generally allow price increases after a drug launches and, in some cases, the national health authority requires patients to switch to less expensive biosimilars once the copycat product is proven safe and effective, said Michael Kleinrock, research director for IQVIA Institute for Human Data Science.
If Susie Christoff, a 59-year-old who suffers from debilitating psoriatic arthritis, lived in Italy, the cost of her preferred medicine would be less than a quarter of what it is in the U.S., according to data gathered by GlobalData, a research firm.
Christoff tried a series of expensive biologics before discovering that a once-a-month injection of Cosentyx, manufactured by Swiss drugmaker Novartis, worked the best.
Susie Christoff enrolled in Medicare after going on disability because of crippling arthritis. Her out-of-pocket cost of nearly $1,300 a month for Cosentyx, which provides relief, is unaffordable, she says. “I am at a desperation level,” Christoff says. (Chris Bartlett/for Kaiser Health News)
Without the medicine, Christoff said, her fingers can swell to the size of sausages.
At first, Christoff’s copay for Cosentyx was just $50 a month. But when a disability led her to switch to a Medicare Advantage plan, her out-of-pocket costs ballooned to nearly $1,300 a month — more than three times her monthly car loan.
Christoff, with the help of her rheumatologist, Dr. Angus Worthing, tried Enbrel, Humira and other drugs before finding Cosentyx, the only drug that provides relief.
Christoff’s case is “heartbreaking,” Worthing said.
Novartis declined to respond to questions about Cosentyx’s price. Instead, like other pharmaceutical companies, Novartis says it offers patient assistance programs for those who can’t afford the drug. Christoff said she doesn’t qualify for financial assistance.
Like other biologics, Cosentyx costs thousands of dollars per month. The annual cost of Christoff’s treatment runs about $65,000 in the U.S. In Italy, where competition and price negotiations play a bigger role, it would run about $15,000, according to GlobalData.
In England, Dr. Christopher Griffiths, a lead researcher at the National Institute for Health Research who treats patients with Cosentyx, said the National Health Service would pay about 10,000 pounds, or less than $13,000.
And those drastic price differences are true even though there is no biosimilar version of Cosentyx yet available in Europe, and might not be for years.
The cost of the drug is taking a toll on Christoff. This past summer, her progressive disease made it difficult to enjoy the annual family vacation with her three grown children and their kids in Virginia Beach, Va.
“I can’t get down on the sand to play with my kids without help. I can’t get up without help,” Christoff recalled. “I’m not ready to stop trying. But I’m also not ready to go through my entire retirement fund to walk.”
Unlike Cosentyx, rival drugs — Humira, Enbrel and Remicade — all face biosimilar competition in Europe. Only Remicade has competition from a lower-cost biosimilar in the U.S., and Humira isn’t expected to have a copycat competitor in the U.S. market until 2023. Humira, made by AbbVie, is the world’s top-selling drug.
In late October, Wall Street analyst Ronny Gal at Sanford C. Bernstein & Co. noted that AbbVie agreed to drop Humira’s price by 80 percent in one Nordic country to combat biosimilar competition. During the company’s quarterly conference call, AbbVie chief executive Richard Gonzalez said the drug’s discount was as low as 10 percent and as high as 80 percent across the continent, with the highest discounts in Nordic countries.
“These are markets where it’s ‘winner takes all’ across the entire … category, so includes Remicade and Enbrel as well,” Gonzalez said in November, adding that Nordic countries represent about 4 to 5 percent of overall revenue in AbbVie’s international business.
Concerned about how much biologics cost the U.S. health system and patients, Food and Drug Administration Commissioner Scott Gottlieb announced an “action plan” this summer that included tapping the Federal Trade Commission for help, saying he was “worried” about the biosimilar market.
“The branded drug industry didn’t build its success by being business naive; they are smart competitors,” Gottlieb told an audience full of advocates, industry insiders and researchers at the Washington, D.C.-based Brookings Institution in July. “But that doesn’t mean we need to embrace all of these business tactics or agree with them and think they are appropriate.”
Food and Drug Administration Commissioner Scott Gottlieb takes questions on biosimilar development during a September public hearing at the agency’s White Oak, Md., campus.(Sarah Jane Tribble/KHN)
One of these business tactics involves so-called rebate traps, in which financial deals are cut to make sure patients can get only a biologic, not a biosimilar. International drugmaker Pfizer alleged in a September 2017 lawsuit that exclusionary contracts created by Johnson & Johnson prevented use of its biosimilar by health insurers, hospitals and clinics.
Johnson & Johnson’s wildly successful biologic Remicade, the brand-name version of infliximab, produced $6.3 billion in worldwide revenue in 2017. Pfizer launched its copycat drug, Inflectra, in the U.S. in October 2016, noting in the announcement that it would price the drug at a 15 percent discount to Remicade’s wholesale price.
Still, health systems such as Geisinger Health, based in Pennsylvania, say they have had difficulty switching to the less expensive alternative.
“J&J has done a really good job of entrenching themselves in the market,” said Jason Howay, manager of formulary services at Geisinger.
The health system ultimately decided it wanted to switch all adults to Pfizer’s biosimilar, saying it provided the same quality of treatment. But Johnson & Johnson had “bundled” the prices of other drugs with Remicade. So if Geisinger stopped using Remicade on adult patients, J&J could stop providing discounts on other drugs, such as those used for cardiology, Howay explained. “It weaves a very tangled web.”
A spokeswoman for Janssen, Johnson & Johnson’s main pharmaceutical subsidiary, says the drugmaker does offer “more attractive contract terms” to buyers who use a wider range of J&J medicines. “Our contracting approach has always prioritized access for patients and their providers,” Meredith Sharp says.
Geisinger negotiated with biosimilar maker Pfizer and won still lower prices to make up for lost savings on the other J&J drugs. It’s now transitioning all adult patients to the less expensive biosimilar.
Another business tactic is creating patent thickets, in which drugmakers win numerous patents to block competitors entirely. Humira, which treats arthritis and Crohn’s disease, has more than 100 patents protecting it in the U.S. By contrast, cheaper biosimilar versions of the AbbVie drug rolled out in October in Europe, where patent laws are less likely to offer such protection.
Such tactics are stifling competitors, according to Bruce Leicher, a former senior vice president and general counsel for Momenta Pharmaceuticals, a Cambridge, Mass., biotechnology company focused on rare-disease drug development. Smaller companies are “struggling now” to plan launches of new drugs. Momenta cut half its staff in October, including Leicher, and announced plans to shift away from five biosimilar development programs.
Leicher said the FDA’s biosimilar action plan under Gottlieb is a good first step but “would have been wonderful to see five years ago.”
Other lingering regulatory burdens have hampered biosimilar adoption as well. This summer, Medicare began reimbursing doctors and hospitals differently for biosimilars. Before that change, patients could pay more out-of-pocket for less expensive rheumatoid arthritis biosimilars than for the brand-name biologics.
And, unlike more chemical compound generics, like aspirin, a pharmacist cannot automatically replace a brand-name biologic with the biosimilar. More than 40 states have passed laws around how and when doctors and pharmacists can substitute a biosimilar for a biologic. Federal guidelines are still not established.
In addition, the FDA requires each biosimilar name to include a random suffix, ostensibly to differentiate it from the biologic drug. That can be confusing and could cause patients and physicians to believe the products are significantly different in quality, said Christine Simmon, who promotes biosimilars for the trade group Association for Accessible Medicines.
She said the naming convention “fuels the fire” of a broader debate about whether to trust biosimilars, adding, “Making sure doctors and patients are comfortable with the products is integral to uptake.”
KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.
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The most expensive drugs of 2019
Americans spend more on prescription drugs than any other population in the world. The average U.S. citizen spends $1,025 per year on medication—that’s an inflation-adjusted 11-fold increase since 1960, according to data from the Peterson Center on Healthcare and Kaiser Family Foundation.
It’s because prescriptions are expensive.
The 10 most commonly advertised drugs have list prices ranging from $488 to $16,938 per month or course of treatment, says the Department of Health and Human Services. And, our research shows that many oft-prescribed medications regularly cost much more than that.
In other words, there are a lot of very costly drugs out there. These are the most expensive drugs, according to SingleCare data. The prices listed below reflect the cash price—what a customer would be expected to pay if he or she did not have insurance or prescription coverage.
28-day supply price: $33,001.08
Afinitor, a chemotherapy medication used to treat kidney, pancreatic, breast, and brain cancers, is one of the most expensive medications out there—but those with a prescription need to have it for their treatment plan. Often, the duration of treatment with Afinitor is defined by the medical diagnosis. Patients diagnosed with Subependymal Giant Cell Astrocytoma received a median duration of treatment of 24.4 months. The median duration of treatment for patients diagnosed with Renal Cell Carcinoma is 141 days. That’s a minimum cost of (gulp): $166, 184.01 for an average treatment cycle.
Currently, there is no generic alternative for the drug to help bring down the costs. A would-be generic manufacturer lost a patent case in courts earlier in 2019, which would have allowed the formulation of a generic version. Cash-paying patients are beholden to the $33,000-plus price tag. But there are ways to save on Afinitor 5 mg tablets. According to Medicare, 100 percent of Medicare Part D and Medicare Advantage plans cover this drug.
28-day supply price: $7,037.81
Humira is an immunosuppressant used to treat arthritis, psoriasis, Crohn’s disease, and ulcerative colitis. It’s been the top-selling (aka the most profitable) drug in the nation since 2012, and shows no signs of slowing down. In 2018, Humira prescriptions topped more than $14 billion, which was an increase of more than 60% than the previous year—despite the controversial reputation of biologic medications.
A 2016 study published by the Journal of the American Medical Association that found “no evidence of an association between research and development costs and prices; rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear.” But still, Humira costs continue to rise. The price of Humira has gone up from about $19,000 a year (in 2012) to more than $38,000 a year (in 2019), per patient, after rebates—according to data reported by the New York Times, from SSR Health, a research firm. That’s an increase of 100 percent. But for those who rely on the drug, there’s good news coming in 2023: a biosimilar drug called Hyrimoz. Not to be confused with generic drugs, biosimilars are “highly similar” medications that are close enough in duplication to accomplish the same therapeutic and clinical results (while generics are chemically identical to the original medication). The FDA has approved Hyrimoz and it will be available for sale in the United States on September 30, 2023.
28-day supply price: $4,944.95
Enbrel is a biopharmaceutical medication that is used to treat rheumatoid arthritis, psoriatic arthritis, and other autoimmune conditions. Just like Humira, Enbrel is seeing a rise in sales and prescriptions filled, despite the wallet-crippling cost. Enbrel—which landed in the U.S. market in 1998—recorded $4.8 billion in U.S. sales in 2018, according to manufacturer Amgen, Inc.
Currently, the drug manufacturer prices a year’s supply of Enbrel’s 50-mg dose at more than $67,000. And there are no generics on the horizon to help ease costs for patients. Two biosimilars of Enbrel were approved by the FDA and have not been launched yet—including one from Swiss drugmaker Novartis AG that the health agency approved in 2016, according to Wall Street Journal health reporter Jared S. Hopkins. More than 40 patents protect Enbrel, and its manufacturer, Amgen Inc., won a court ruling in August related to Enbrel patents.
30-day supply price: $4,694.13
Xeljanz is a popular biopharmaceutical that is prescribed to treat rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. But recently, the drug made headlines because of the new FDA black-label warning that the JAK inhibitor’s 10-mg twice daily dose, which was formulated to ease joint pain and swelling, increases risk of blood clots—and potentially, death.
The drug’s approval to treat ulcerative colitis has been nixed—it’s now only approved for patients who do not respond to or are not suitable for other medicines. But despite all the serious warnings surrounding the 10-mg dose, the 5-mg is still considered safe, and in turn has seen an increase in sales and use.
28-day supply price: $3,639.85
Forteo is an injectable medication that helps strengthen bones for people with osteoporosis who are at high risk of a fracture—especially those with osteoporosis from taking steroids like prednisone. It’s a synthetic form of a hormone naturally found in the body that promotes growth of new bone and increased bone density. Injections are typically taken in the thigh or belly. It’s approved for up to 24 months of use.
There is currently no generic available. But, Pfenix won patent approval for a similar product, which could drive the price down when it hits manufacturing. There are already two comparable treatments in Europe, but they have been blocked in the United States. If you need Forteo, there is a manufacturer’s discount available for eligible patients.
6. Glatiramer Acetate Injection
30-day supply price: $3,378.50
Glatiramer acetate injection is the generic version of Copaxone, an injectable medication used to treat multiple sclerosis and prevent MS relapse. Even as a generic, the price is high—not much lower than the brand-name counterpart.
In the past 20 years, there have been big advances in MS treatment, but the increase in available treatment options has not led to a parallel decrease in prices. They have been escalating. From 2013 to 2018, the average median cost of disease modifying therapies like glatiramer acetate rose from $60,000 to $80,000 according to the National Multiple Sclerosis Society. If you’re having trouble affording your medication, Mylan offers savings for certain people.
7. Norditropin Injection
30-day supply price: $3,377.89
Norditropin is a synthetic growth hormone that imitates hormones in the pituitary gland that stimulate growth in the body: height, organs, bones, and muscles. When used for children who don’t make enough growth hormone, it can help them become taller. For adults, it can stimulate muscle growth. When used for patients without a deficiency, it’s not effective.
It’s considered a specialty medication, like those used to treat conditions such as cancer, HIV, or rheumatoid arthritis. These types of medication are typically more expensive, and norditropin is no exception. Novo Nordisk has a patient assistance program in place to help navigate insurance benefits and afford medications.
30-day supply price: $3,356.06
Stribild is a four-medication cocktail in one tablet used to treat HIV and lower the risk of transmitting the condition to others. It contains three antiretroviral medications and a medication that helps the others work better. Though pricey, there’s some evidence that once a day combination treatments for HIV are less expensive long term than some other options because they improve medication adherence in patients, which can lower risk of complications or expensive hospitalizations. The manufacturer of Stribild, Gilead, offers patient assistance programs if you’re having trouble affording the treatment.
30-day supply price: $3,215.15
Atripla is another combination medication used to treat HIV, and lower the risk of transmitting the condition to others. It contains three medications. There is currently no generic version of this medication available, which keeps the price high. But, starting at the end of September 2020, Teva Pharmaceuticals is approved to launch generic versions, which could help to ameliorate the cost. The manufacturer of Atripla, Gilead, offers patient assistance programs if you’re having trouble affording the treatment.
30-day supply price: $3,214.05
Biktarvy is a three-medication combination pill used to treat HIV. There is no generic version available. New data shows it’s very effective in new patients, and patients switching from other medications, which has led to nearly-quadrupling sales of this medication in a single year despite the expense. Like other combination medications for HIV, there is some evidence that it reduces long-term treatment costs because of improved adherence. The manufacturer of Biktarvy, Gilead, offers patient assistance programs if you’re having trouble affording the treatment.
So what’s causing the high prices?
How (and why) is the cost for so many necessary medications get so high? It’s complicated—and impacted by a number of factors.
The brand-name market is where medications are first created, and developing a new medication is an expensive and time-consuming process. “Brands have patent and regulatory protection in their early market years, enabling manufacturers to take full advantage of demand for their novel treatments, and reward investors for their patience and high cost of research and development,” explains Dana Goldman, director’s chair at the USC Schaeffer Center for Health Policy and Economics and Professor of Public Policy, Pharmacy, and Economics. In other words, prices of new treatments are high because of the high cost of bringing them to market.
In the generic market, it’s a different story. When a patent on a new drug ends, manufacturers can create a generic version and sell it for a much lower price because the original developer has recouped costs. Yet, occasionally, generics are just as expensive as their branded counterparts, such as the sudden price sprike for the antimalarial drug Daraprim, which made the news in 2015.
Martin Shkreli and Turing Pharmaceuticals took the $13.50 per pill Daraprim (which has been available since the 1950s) and increased the price to $750 per pill. Shrkeli could do this because the price of Daraprim had dropped so low that all the suppliers had opted out. Turing then swooped in and leveraged its monopoly power over a drug that had no patent protection.
This proves how, ironically, the generic medication market can sometimes work too well: Drugs get too cheap too quickly and adequate supply is jeopardized.
How SingleCare can help
Due to the high cost of medication, more and more people rely on healthcare companies like SingleCare to help them save hundreds (and thousands) of dollars on their prescriptions. “At SingleCare, we believe it’s really important to provide prescription discounts to everyone in America that are free to access, regardless of insurance status,” says Manav Malhotra, VP of data at SingleCare. “And as we strive to make drugs more affordable and accessible, a big part of that is making sure there is price transparency for the consumer.”
And while Americans are used to shopping around for prices, they don’t do it with medications. “It’s hard to imagine purchasing any product without any idea of what it’s going to cost you until you get to the register, but that’s traditionally how the pharmacy industry worked,” Malhotra says. “We want consumers to know exactly what they are going to pay at any of our pharmacy partners before they set foot inside. Many consumers don’t even realize that prices vary between pharmacies just across the street from each other. A market driven by an informed consumer making informed decisions is the first step toward lowering prices.”
SingleCare offers price transparency charts that let you compare the cash price to the SingleCare savings for drugs over the past year. And, our Drug Basket feature allows you to bundle prescriptions to save more at one pharmacy, without running all over town to get the best deals.
Offering the best possible savings is at the heart of everything SingleCare does. “We also look at the drugs that consumers really care about to determine where to focus our efforts on driving prices down,” Malhotra says. “It drives how we make our pricing decisions and our discussions with our pharmacy partners.”
Check out our prescription coupon finder here to see how much you can save.