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Tag: Humira

  • Why do people pay so much for Humira now that it’s off-patent?

    Why do people pay so much for Humira now that it’s off-patent?

    Humira, the exorbitantly priced drug taken by millions of Americans, finally lost its patent at the end of 2022, five years later than in Europe. But, even though biosimilar drugs are available, people’s out of pocket drug costs for this drug continued to be high. The drug rebate system in the US benefits drug middlemen and insurers and hurts patients, reports Joshua P. Cohen for Forbes.

    In short, pharmacy benefit managers (PBMs) make a fortune negotiating drug discounts from manufacturers. They usually see these discounts in the form of rebates, which they can pocket and/or share with the insurers offering prescription drug coverage. Americans rarely see the benefits of these rebates.

    Moreover, PBMs, which determine which drugs an insurer covers on its formulary and at what copay, can opt not to include drugs on the formulary. So, Humira’s manufacturer, AbbVie gave PBMs a huge rebate to include Humira on their formularies. The PBMs could then opt not to include biosimilar equivalents on their formularies or to make the biosimilars more expensive to enrollees, in order to maximize profits.

    That appears to be what’s happening. PBMs are not making it easy and inexpensive for people to get a biosimilar drug, even though there are more than ten of them available on the market. These biosimilars had only two percent of market share last March, after being available for 15 months.

    Now, more people are taking a biosimilar of Humira. The big PBMs are finally offering biosimilars. But, CVS and Express Scripts, two PBMs, are doing so with a biosimilar from which they receive a co-branded licensing fee and discounts, in order to continue to maximize their profits from the drug. They steer their customers to their biosimilars, which are often more costly than others.

    What you can do? Shop around. Check out Mark Cuban’s Cost Plus Drugs, Costco and other sources for a lower-cost biosimilar.

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  • CVS profits from manufacturing its own generic drugs

    CVS profits from manufacturing its own generic drugs

    CVS has become the sixth largest corporation in America, owning not only a chain of pharmacies, but health insurance company Aetna, and Pharmacy Benefit Manager (PBM), Caremark, among other big businesses. To maximize profits, CVS offers many private label products. To increase those profits further, CVS has begun to sell its own prescription drugs, reports David Wainer for the Wall Street Journal.

    Bottom line, CVS believes that selling its own biosimilars will generate handsome profits. CVS can steer its customers to these generic drugs through its Pharmacy Benefit Manager or PBM, which determines the drugs on many insurance companies’ formularies, including Aetna’s. In the process, CVS can put competitor manufacturers with lower-cost biosimilars out of business.

    The Cordavis unit of CVS Health – lord knows how CVS came up with the name—works with drug manufacturers to create the biosimilars CVS sells. Biosimilars are the generic version of biologicals, prescription drugs made from living cells. The biosimilar market is booming as more blockbuster biologicals, such as Humira, lose their patents.

    Beginning shortly, Humira will no longer be available on CVS formularies. CVS will offer its biosimilar. Similarly, Cigna, which has its own PBM, Express Scripts, will take Humira off its formulary and instead offer its private label biosimilar. For now, the cost will be low for patients, 85 percent lower than Humira’s list price, with no out-of-pocket costs to patients.

    CVS projects that the biosimilar market will grow exponentially in the next five years to $100 million. It was not even $10 million just two years ago. CVS will steer its customers away from brand-name biologicals to its biosimilars and profit big time in the process. Over time, will patients save money and how much? That’s largely up to CVS, an untenable truth.

    The bigger question is how will patients fare as biologicals are replaced by biosimilars? It’s not at all clear; at least for now, it is out of government hands. PBMs, such as CVS Caremark, can and will use their power to determine which drugs people use and at what cost in order to maximize their profits. Before long, some say it’s likely that there will be no prescription drug price competition, only strategies among the PBMs and insurers to maximize profits.

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  • Insurers promote Humira over lower cost alternatives

    Insurers promote Humira over lower cost alternatives

    Humira, which treats rheumatoid arthritis and costs a small fortune, is a blockbuster drug that millions of Americans depend on. Fortunately, there are now far lower-cost biosimilar alternatives. Arthur Allen reports for Kaiser Health News that health insurers and the drug company middlemen they work with have no interest, and everything to gain, from not promoting biosimilars, needlessly costing our health care system hundreds of millions of dollars a year.

    Humira is a biologic, made with living cells, with a list price of $6,600 a month, while biosimilars cost just under $1,000 a month. So, if the prescription drug marketplace worked, most everyone would be taking the biosimilar. But, the Pharmacy Benefit Managers or PBMs, who are responsible for designing insurer formularies– the list of prescription drugs an insurer covers and at what copay–have a financial interest in continuing to steer people to Humira, as do the insurers.

    Even though Humira’s list price has increased six-fold since it was first launched in 2003, the PBMs make money offering it, as do the health insurers. The PBMs receive rebates from Humira’s manufacturer, AbbVie, for promoting the drug and share the rebate with the insurers. The only people who lose are the insureds.

    If 313,000 people who take Humira instead took a biosimilar, the equivalent of a generic version, our health care system could spend about $9 billion less. But, companies manufacturing the Humira biosimilar can’t afford to give PBMs big rebates. So, the PBMs are less interested in promoting their drugs.

    Other wealthy nations don’t have PBM middlemen and therefore don’t deal with these gross financial incentives that drive up health care costs. In other countries, almost everyone has switched to a Humira biosimilar. With the profit motive driving insurers and PBMs in the US, however, it’s not clear whether companies manufacturing biosimilars can survive here.

    It costs about $200 million to develop a biosimilar. Without substantial sales, it’s not worth the effort. Unless Express Scripts, Optum Rx, and CVS Caremark three large PBMs, reduce the copay for the Humira biosimilar so that it’s less than the copay for Humira, doctors are not likely to prescribe the biosimilar, and the PBMs will kill the biosimilar market.

    What’s crazy is that the price of biologics continues to rise at a rate of 12.5 percent a year over the last five years, and it is not affecting the market for them, even when there are biosimilars.

    Allen reports that AbbVie is telling health insurers that, if they promote biosimilars over Humira, AbbvVie will cut the rebates it pays them for Humira and other drugs it manufacturers. AbbVie also reportedly increased rebates to PBMs for Humira.

    To be clear, even though patients might have the same copay for Humira as for a biosimilar, their health insurance premiums are significantly higher because people take Humira and not a biosimilar. Humira costs more. Moving to the biosimilar would reduce health care spending and make health care more affordable, helping to ensure people get needed care.

    Even with Medicare, the annual copay for Humira can be as high as $8,000.

    Doctors don’t steer their Humira patients to biosimilars as they tend not to want to switch their patients off medications that work. Even though the biosimilars appear to be as effective as Humira, if patients aren’t saving money by switching off Humira, they have no interest in messing with their drug regimens.

    Small PBMs and insurers who don’t make their money off of drug rebates, such as Prescryptive and Kaiser Permanente, have moved most of their patients to biosimilars, saving their patients money. Prescryptive says that switches to biosimilars have happened “with absolutely no interruption of therapy, no complaints, and no changes.”

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  • Biden administration penalizes drug companies hiking drug prices above the rate of inflation

    Biden administration penalizes drug companies hiking drug prices above the rate of inflation

    The Inflation Reduction Act (IRA), which became law in August 2022, appears to be working to rein in the ever-escalating price of some prescription drugs. Jonathan Cohn writes for the Huffington Post about 43 prescription drugs with price increases greater than the rate of inflation. The Biden administration has signaled them out for Medicare savings, imposing penalties on the drug companies that manufacture them.

    Humira, a very popular drug that treats inflammatory conditions, and Leukine, a drug that protects people on chemotherapy from infections, are two drugs with big price hikes that the Biden administration has identified. As a result of the IRA, our federal government will impose monetary penalties on drug companies manufacturing  the 43 drugs with excessive price increases. And, people with Medicare who take any of these drugs will pay lower coinsurance for them, saving $1 to $449 per prescription.

    None of the drugs on this initial list are prescription drugs covered under Medicare Part D. Rather they are all administered by a doctor and are covered under Medicare Part B, under which people pay 20 percent coinsurance if they do not have supplemental coverage to pick up that cost. People with supplemental coverage should also benefit from the IRA because the government penalties should help keep their supplemental insurance premiums down.

    Over time, the list will grow to the extent pharmaceutical companies raise prices at rates greater than the rate of inflation. And, the list will include drugs covered under Medicare Part D.

    The IRA also caps insulin costs for people with Medicare to $35 a month. And, beginning in 2025, the IRA caps out-of-pocket spending under Medicare Part D at $2,000 a year.

    All these advances to curb prescription drug costs for the Medicare program and the older adults and people with disabilities who count on Medicare are meaningful. These reforms will make it much easier for many people to get their drugs. But, the IRA still leaves people with Medicare paying far more than people in other wealthy countries for their drugs. And, even with the IRA, pharmaceutical companies can gouge Americans when it comes to drug prices.

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  • Drugmaker charged with paying kickbacks to sell more Humira

    Drugmaker charged with paying kickbacks to sell more Humira

    Humira is one of the top-selling drugs in the US. But, it may be in part because its drugmaker, AbbVie, has paid kickbacks to doctors and nurses to sell more Humira. The California insurance commissioner has filed a lawsuit alleging that AbbVie engaged in a range of illegal activities to promote the sale of Humira, which cost the state $1.2 billion.

    To get doctors to write more prescriptions for Humira, a drug that treats rheumatoid arthritis, the California insurance commissioner claims that AbbVie paid doctors cash and gave them gifts and patient referrals. According to the commissioner, AbbVie also hired nurse “ambassadors,” who claimed to be patient advocates, to make sure patients were taking the Humira their doctors prescribed and refilling their prescriptions. These same nurses also made visits to doctors’ offices with Humira sales reps.

    Over a five-year period, commercial insurers paid 274,000 claims for Humira prescriptions. And, the price for Humira is high in part because AbbVie has been able to get new patents approved for the prescription drug and extend its monopoly pricing power; it has 247 patent applications for this drug alone. So, Humira’s price has more than doubled (increasing 144 percent) in six years.

    AbbVie denies any wrongdoing, claiming that it was simply helping patients, providing “support services,” to them. It claims no interference between patients and health care providers. However, the lawsuit alleges that these nurses placed themselves between patients and their doctors, with a responsibility of keeping patients on Humira and reporting complaints to AbbVie, not the patients’ doctors.

    AbbVie contends that it provided professional services to help doctors with insurance processing, prior authorization, and more, in order to save them time and money. It also takes the position that several of the allegations in the lawsuit included proprietary information that should not be publicly disclosed so that, for now, the lawsuit has been substantially redacted.

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  • Multiple patents drive up drug prices

    Multiple patents drive up drug prices

    Many prescription drugs have patent protections that deliver monopoly pricing power to their manufacturers for far longer than the 20-years intended by the US patent law. A recent report by I-MAK finds that the top 12 drugs in the US have an average of 71 patents each. Multiple patents drive up drug prices in the US. Not surprisingly, Americans are struggling to afford critical medications.

    In the last six years, prices on these 12 top-selling prescription drugs have increased an average of nearly 70 percent. Four of these drugs have seen their prices more than double since 2012–Lyrica (163%), Enbrel (155%), Humira (144%), and Lantus (114%).

    And, four of these 12 drugs have already benefited from patent protection for 20 years. Still, their manufacturers continue to seek patent protections for many more years–Herceptin, Rituxan, Biogen, Enbrel and Remicade. This practice of extending patents through modest changes to a drug is called “evergreening.”

    AbbVie manufactures Humira, the top-selling drug in the US. It has 247 patent applications for Humira. Roche/Genentech first filed for patent protection for Herceptin, a cancer drug, in 1985. Today, it continues to file patent applications, which could extend its monopoly pricing power as long as 48 years, until 2033.

    We need to reform the patent system and stop these patent abuses. We need generic competition in the prescription drug marketplace. It could help drive down drug costs. For now, 19 million Americans are forced to buy their prescription drugs from abroad, where prices are significantly lower.

    If you believe Congress should rein in drug prices, please sign this petition.

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