Paying for Biologics to Treat RA: Where to Find Help

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

Why do they cost so much? What can you do to get the medication you need?

Why Biologics Are So Expensive

There are many reasons:

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 is higher, too. Biologics use technology called genetic modification. Simply put, biologics target specific parts of RA’s inflammatory process while sparing others. Drugmakers say the cost of researching and developing these drugs makes them much more expensive than chemical drugs.

There isn’t as much brand competition. Because many biologics work in different ways to ease inflammation, there aren’t as many similar drugs. As a result, pharmacy benefit managers can't negotiate prices for them.

The way they are given. You’ll get some biologics by IV in a rheumatologist's office or infusion center. You take DMARDs by mouth at home. The fact that some biologics are taken by IV also affects the way Medicare will reimburse you for them.

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 that, there are still ways to get the medications your doctor recommends:

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 copayments 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, talk with your doctor or check the company's website.

State programs: Some states offer help to older and disabled people without drug coverage. To learn more about what your state offers, visit the Medicare website and search "prescription drug assistance."

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Private foundations: Some organizations help folks with low and moderate incomes afford their medicines. If you risk going without drugs you need, your doctor may know an organization that can help. So don’t be afraid to ask. NeedyMeds has information on more than 2,400 drug assistance programs. The Partnership for Prescription Assistance and Rx Assist also can point you in the right direction.

Pharmacy discount programs: Some pharmacies have discount programs. Ask yours what it offers.

Efforts to Make Biologics More Affordable

Now, there are things called “biosimilars” available for some biologics. As the name implies, these more affordable alternatives are similar, but not identical, to the original biologic.

Trials must show that a biosimilar drug is as safe and effective as the original biologic. The FDA is still refining  the requirements a drug will have to meet to be called "biosimilar." There are currently several available and more to come

WebMD Medical Reference Reviewed by David Zelman, MD on November 10, 2017

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, MS.

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

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