Paying for Biologics to Treat RA: Where to Find Help

The biologic therapies for rheumatoid arthritis are effective. They reduce some of the signs and symptoms of RA, such as the number of tender or swollen joints, pain, and disability. And they can slow or stop joint damage. But relief doesn't come cheap. Biologics can be expensive, even with medical insurance.

Why do biologics cost so much? WebMD helps you understand the high cost of biologics and what you can do to get the medication you need.

Why Biologics Are So Expensive

There is a number of reasons why biologic therapies for RA are more expensive than traditional disease-modifying antirheumatic drugs (DMARDs). Biologics work by targeting specific parts of the body's immune system to combat inflammation that damages joints. Here are some of the major reasons biologics are costly:

  • The cost of making them. Biologic agents are more expensive to make than chemical drugs like DMARDs. The materials needed to create them cost more, and the manufacturing process, which uses live organisms, is more complex.
  • The cost of research and development. Developed through technology called “genetic modification,” biologics target specific parts of the inflammatory process involved in RA while sparing others. Drugmakers say the cost of researching and developing these drugs makes them much more expensive than chemical drugs.
  • Less brand competition. Because many of the biologics work in different ways to reduce inflammation, they face less competition from similar drugs. As a result, pharmacy benefit managers aren't able to negotiate prices for biologics.
  • The way they are given. Some of the biologics are infused in a rheumatologist's office or infusion center. By contrast, most traditional DMARDs are taken by mouth at home. The fact that some biologics are infused also affects the way Medicare reimburses for them.
  • Lack of generics. When a drug company applies for a patent, it has exclusive rights to make and market the drug during a certain period of time. After that time, other companies can make cheaper generics. All of the current biologics are still under patent protection.

What If You Can't Pay?

If your doctor prescribes a biologic to treat your RA and your insurance covers it, your portion of the payment can still sometimes run hundreds of dollars per month.

If you can't afford the cost, there are still ways to get the medications your doctor recommends. Here are some methods to try:

  • Patient assistance plans: Most, if not all, companies that make biologics offer plans to help people who can't afford them. These programs may cover co-payments or, in some cases, offer the drugs at a discount or for free. To find out if the drug company that makes your biologic offers assistance, speak with your doctor or check the company's web site.
  • State programs: Some states offer programs to help older and disabled citizens without drug coverage. To learn more about these programs and what your state offers, visit the Medicare web site and search "prescription drug assistance."
  • Private foundations: Some organizations help patients with low and moderate incomes with medication costs. If you risk going without drugs you need, your doctor may be aware of an organization that can help. NeedyMeds provides information on more than 2,400 drugs assistance programs. The Partnership for Prescription Assistance and Rx Assist also have information on patient assistance programs.
  • Pharmacy discount programs: Some pharmacies have discount programs. Ask if your pharmacy has a program and what benefits are offered.

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Efforts to Make Biologics More Affordable

Part of the Healthcare Reform Act targeted the creation of cheaper versions of biologic drugs (often called "follow-on biologics"). After a company has produced a biologic drug under patent for 12 years, other companies can produce similar versions of that drug, known as "biosimilar" drugs. But the process involved in producing a biosimilar drug is more complicated than it is to produce a traditional generic drug.

Biologic drugs are made from proteins taken from living cells. It's harder to prove that a biosimilar drug is as safe and effective as the original biologic. The FDA is still devising the requirements a drug will have to meet to be called "biosimilar."

Because companies may have to fund clinical studies to prove their drugs are biosimilar to the original, consumers may not save much with biosimilar drugs. It will be a while before we know how much money people might truly save with these drugs.

WebMD Medical Reference Reviewed by David Zelman, MD on November 18, 2015

Sources

SOURCES:

Welch, B. American Family Physician, December 2008.

The Johns Hopkins Arthritis Center: "Rheumatoid Arthritis Treatment."

Arthritis Today: "Drug Guide: Biologics."

Kaiser Health News: "Checking In With Patricia Danzon on the Hot Topic Of 'Biologics.'"

David I. Weiss, MD, rheumatologist, Arthritis Associates, Hattiesburg, Miss.

Medicare.gov: "5 Ways to Lower Your Costs During the Coverage Gap" and "Help with Medical and Drug Costs."

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