Humira Price for Commercial Plans Remained Steep Despite High Rebates

Despite increasing rebates, the net price of Humira for Medicaid and commercial health plans in 2020 remained high above the launch price, according to a study published in JAMA Network Open.

The first biosimilar of Humana, the brand name of adalimumab, was launched in January 2023 by Amgen. The pharmaceutical company introduced two versions of the biosimilar Amjevita: one with a list price of 55 percent below Humira and another with a list price of 5 percent below Humira and an expected 50 percent rebate.

To contextualize the biosimilar prices and examine potential savings, researchers estimated commercial and Medicaid net prices of Humira after accounting for rebates negotiated with pharmacy benefit managers (PBMs).

Between 2013 and 2020, the list price for original Humira rose by 141 percent from $1,153 to $2,784. PBM rebates increased from $28, 2.4 percent of the list price, to $973, 34.9 percent of the list price.

The average net price for commercial and Part D plans grew from $1,125 in 2013 to $1,906 in 2018, indicating a 69 percent increase. The net price fell to $1,812 in 2020.

The Medicaid base rebate was 23.1 percent of the list price from 2013 to 2018. After 2019, PBM rebates surpassed 23.1 percent of the list price and set the best price.

Meanwhile, the Medicaid inflation rebate for Humira increased from 38.6 percent of the list price in 2013 to 69.9 percent in 2019. As a result, the net price of Humira for Medicaid fell from 38.3 percent of the list price in 2013 to 8.3 percent in 2018 and finally to 0 percent in 2019, when rebates exceeded the list price.

Citrate-free Humira saw lower inflation rates, leading to a higher Medicaid net price, the study noted.

Even as rebates generally increased for Humira, the drug’s net price for commercial and Part D plans in 2020 was still 3.5 times the launch price of $522. In addition, Amjevita, with the 55 percent discount, still costs more than double Humira’s launch price, researchers said.

Pharmaceutical companies are expected to launch interchangeable versions of Humira in the second half of the year.

“These formulations may compete more directly on list price, marketing to pharmacies seeking to source lowest-cost product to generate a margin when reimbursed by an insurer at a predetermined amount for interchangeable formulations,” researchers wrote.

The expected biosimilars will only be interchangeable with original Humira and not the citrate-free version, they noted.

The Humira citrate-free pen appeared in the ten top-selling drugs in 2021 and accounted for $2.9 billion of the $216 billion in total gross spending on Medicare Part D drugs, a KFF analysis found. Together, the ten top-selling drugs accounted for 22 percent of total Medicare Part D spending.