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.
SPEAKER: There are
several effective treatments
for RA, including DMARDs
Both types of medications
control rheumatoid arthritis
by lowering the inflammation
that fuels it, but there are
differences between them.
Your doctor is more
likely to prescribe DMARDs
These drugs fight inflammation
by turning down
your immune system
or by targeting
certain immune cells.
They come in pills, shots,
or infusions through a vein.
You may need to take more
than one type of DMARD
your rheumatoid arthritis
If traditional RA drugs don't
help, your doctor may prescribe
you a biologic.
These drugs target
specific immune system proteins
called cytokines to bring down
Biologics may give you relief
more quickly, but they can be
expensive, and you can only get
them through shots or IV
Whether you take a DMARD,
biologic, or a combination
of both, these drugs can slow
or stop RA from getting worse.
And that can make a world
of difference for your joints.
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."
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