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Copycat drugs could end Humira's reign as the prominent arthritis treatment

A MARTÍNEZ, HOST:

The blockbuster drug Humira has been one of the world's top sellers for more than two decades. But thanks to some copycats, including one that's going to be sold at entrepreneur Mark Cuban's online pharmacy, Humira's reign could be coming to an end. NPR pharmaceuticals correspondent Sydney Lupkin reports.

SYDNEY LUPKIN, BYLINE: Humira is an injectable drug approved in 2002 that treats a range of illnesses, including Crohn's disease and rheumatoid arthritis. The drug is popular with patients but has a list price of nearly $7,000 a month. Even with insurance, the drug, made by AbbVie, can be quite expensive. There was no direct competition for years. The company protected the drug with a thicket of patents. Here's Ameet Sarpatwari of Harvard Medical School.

AMEET SARPATWARI: It's fair to say that Humira is the poster child for what plagues the system, and that is an enormous amount of patents protecting various aspects of the molecule, some of which are undeserved.

LUPKIN: In 2016, the FDA approved the first drug that was a close copy of Humira. Humira is an antibody-based drug, and the copies aren't identical. The alternative medicines are called biosimilars. But the first Humira biosimilar and the handful that followed couldn't come to market until this year because of disputes over all those patents. As of this month, there are nine Humira biosimilars for sale. But so far, not a whole lot of people are buying them. Here's Sarpatwari again.

SARPATWARI: The reason prices haven't changed overnight is because we have a Byzantine, opaque and, in some respects, perverse pharmaceutical system from the manufacturer through what's called the pharmacy benefit manager, all the way to the pharmacy.

LUPKIN: That pharmacy benefit manager he's talking about decides which drugs you can get with your insurance card and how much you pay for them. These middlemen purchase drugs and then get a chunk of that money back from the drugmakers through rebates. The size of the rebate is usually secret but often influences which drug products get better market share. So even if a competing drug's price is lower, it might not wind up on the menu of drugs or formulary that your insurance will pay for. Karen Van Nuys is a senior fellow at the Schaeffer Center for Health Policy and Economics at the University of Southern California.

KAREN VAN NUYS: Who is the pharmacy benefit manager going to put on the formulary? And in many cases, it's believed that they prefer the higher rebate drug.

LUPKIN: But that could change for Humira because of a biosimilar called Yusimry. The drug, made by Coherus BioSciences, just launched and is being sold for about $1,000 a month. It'll be even cheaper through Mark Cuban's online pharmacy Cost Plus, where there will be no rebate to a pharmacy benefit manager. The price tag is about $570 a month, plus shipping and fees. Coherus BioSciences' chief business and legal officer Chris Levinsky says a rock bottom price is needed to help patients.

CHRIS SLAVINSKY: How can we take this but stay true to our core values of driving access? And that became the seed that ultimately became the low list price.

LUPKIN: Coherus priced its biosimilar so low that pharmacy benefit managers may opt to forego the big Humira rebates. That's because Humira is so popular. Humira and drugs like it account for so much drug spending that switching patients to Yusimry could allow plans to lower premiums. And employers making their annual choice of health insurance plans for employees care about saving money on Humira. Here's Richard Evans, a pharmaceutical industry veteran who runs SSR Health.

RICHARD EVANS: You're not really just paying to be aggressive, to try to take that 11% of your spending and reduce it as much as possible, because all the savings that you can create can be put back into lower premiums.

LUPKIN: Or employers will pick a different plan. Time will tell if cheaper challengers to Humira catch on.

Sydney Lupkin, NPR News. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Sydney Lupkin is the pharmaceuticals correspondent for NPR.