FAQs about the cost of biologics

How much do biologics cost out of pocket?

Biologics are expensive without insurance. For example, the cash price of the brand-name drug Enbrel is about $9,696 for 4 syringes of 50 mg/1 mL. The cash price for Humira is around $8,811 for 2 autoinjector kits, and for Dupixent, it is roughly $5,520 for 2 pens (300 mg/2 mL each).

Using a free SingleCare coupon can help lower the out-of-pocket cost for biologic injections by thousands of dollars.

Are biologics and biosimilars covered by insurance?

Insurance coverage for biologics and biosimilars can vary widely from one plan to another. Many commercial insurance plans and Medicare Part D cover popular biologics like Humira and Enbrel. However, they are often placed on higher-cost specialty tiers, which can mean higher copays or coinsurance.

Medicaid generally covers FDA-approved biologics and biosimilars. However, each state has its own list of covered drugs (formulary) and its own rules for prior authorization, so you’ll need to check your specific plan.

Sometimes, insurance coverage requires step therapy. For many biologics and biosimilars, insurance providers require patients to have tried a conventional DMARD before approving the biologic, but this depends on the plan and disease being treated.

Why are biologics so expensive?

Unlike traditional drugs, which are made from simple chemical compounds, biologics are made from living cells in very specialized labs. They are much more complicated and expensive to make. Developing a new biologic can take more than 10 years and can cost billions of dollars, according to the Accreditation Council for Medical Affairs, and there’s no easy generic version, unlike many conventional medications. Limited competition often keeps biologic prices high, even after they’ve been on the market for years. This is a big reason why understanding biologics vs. biosimilars is so important when you're trying to find more affordable treatment options.

Why are biosimilars cheaper than biologics?

Biosimilar drug manufacturers are not required to repeat the large, costly clinical trials that were done for the original biologic. Instead, they must show that their medicine is highly similar to the biologic version, with no meaningful differences in how well it works or how safe it is, according to the U.S. Food and Drug Administration (FDA). This significantly reduces development time and biosimilar cost, and manufacturers can pass those savings on to you.

For example, the Humira biosimilar price is a fraction of the brand-name price. Humira retails for about $8,811 for 2 autoinjector kits, while Hadlima (adalimumab-bwwd), a Humira biosimilar, costs around $1,372 for 2, 40 mg/0.8 mL syringes. That adds up to a savings of more than 80%. If you add a SingleCare coupon on top of the cash price, you’d save almost $8,000.