What Are Remicade and Avsola?
Remicade (infliximab) is the original, brand-name biologic medication, first approved by the FDA in 1998. As a tumor necrosis factor (TNF) blocker, it is used to treat various autoimmune conditions, including Crohn's disease, ulcerative colitis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis. Biologic drugs are complex, large-molecule medications derived from living organisms.
Avsola (infliximab-axxq) is a biosimilar to Remicade, approved by the FDA in 2019. A biosimilar is a biologic product that is highly similar to a reference product (Remicade, in this case) and has no clinically meaningful differences in terms of safety, purity, or potency. Like a generic small-molecule drug, a biosimilar enters the market after the reference product’s patent expires, introducing competition and driving down costs.
Direct Price Comparison: Remicade vs. Avsola
Comparing the cost of Remicade and Avsola is complex because the list price is not the final amount paid by patients or even healthcare providers. However, looking at the Wholesale Acquisition Cost (WAC) provides a clear picture of the initial price difference. As of Q4 2024, the WAC for a 100 mg vial of Avsola was significantly lower than Remicade. This price reduction is a direct result of market competition introduced by biosimilars like Avsola.
Factors Influencing Out-of-Pocket Costs
For patients, the list price is often less important than their final out-of-pocket cost, which can vary dramatically based on several factors:
- Insurance Formulary: Many health insurers, such as United Healthcare and Aetna, now list biosimilars like Avsola as a 'preferred' infliximab product, which can lead to lower copayments or coinsurance for patients. Remicade may be placed on a 'non-preferred' tier, requiring patients to try a biosimilar first in a process known as step therapy.
- Prior Authorization: Regardless of formulary status, both Remicade and Avsola require prior authorization from most insurers. The prescribing doctor must provide documentation to prove the medication is medically necessary.
- Deductibles and Coinsurance: Patients must meet their annual deductible before insurance begins covering a significant portion of costs. Biologics, especially infusions, are often subject to a coinsurance percentage rather than a fixed copay, meaning patients pay a percentage of the total cost.
- Infusion Site: The location of the infusion can heavily influence the final bill. Infusions administered in a hospital outpatient setting often have higher facility fees compared to freestanding infusion centers.
- Weight-Based Dosing: Both drugs are dosed based on a patient's weight, meaning larger patients will require more vials per infusion, increasing the total cost per treatment.
Financial Assistance Programs: Getting Help with Costs
Recognizing the high cost of biologic drugs, manufacturers and third-party organizations offer financial assistance programs to reduce the burden on patients.
- For Avsola: Amgen offers the Amgen SupportPlus Co-Pay Program. For commercially insured patients, this program can reduce out-of-pocket costs to as little as $5 per treatment, covering deductibles, copayments, and coinsurance up to a maximum annual benefit.
- For Remicade: Janssen, the manufacturer of Remicade, provides the Janssen CarePath Savings Program. This program also offers significant financial assistance to commercially insured patients, with eligible individuals paying as little as $5 per infusion.
- Third-Party Foundations: Independent charitable foundations, such as the Patient Access Network (PAN) Foundation and the HealthWell Foundation, may offer financial aid for both medications to eligible patients who meet specific income and insurance criteria.
Comparison Table: Remicade vs. Avsola
| Feature | Remicade (infliximab) | Avsola (infliximab-axxq) |
|---|---|---|
| Drug Type | Original Biologic | Biosimilar to Remicade |
| Manufacturer | Janssen | Amgen |
| FDA Approval | August 1998 | December 2019 |
| Therapeutic Equivalence | Clinically equivalent to Avsola | Clinically equivalent to Remicade |
| List Price (WAC, Q4 2024) | $1,168 per 100mg vial | $500 per 100mg vial |
| Financial Assistance | Janssen CarePath Savings Program | Amgen SupportPlus Co-Pay Program |
| Insurance Status | Often non-preferred with more restrictive coverage | Often preferred with potentially lower patient costs |
| Patient Population | Used for autoimmune diseases like Crohn's, RA, UC | Approved for the same indications as Remicade |
Conclusion: Making an Informed Financial Decision
When considering how much is Remicade vs Avsola, the most salient point for patients is that Avsola is the lower-cost product at the wholesale level. This market competition has also driven down Remicade's average price, but biosimilars remain the more affordable option. However, the ultimate out-of-pocket cost is dictated by a patient's specific health insurance plan and their ability to qualify for financial assistance. While the clinical efficacy and safety of the two drugs are highly similar, navigating insurance formularies and comparing financial support programs is crucial for managing treatment expenses. Patients should work closely with their doctor's office and insurance provider to understand their specific coverage and the most cost-effective path to treatment, as many insurers actively encourage or mandate the use of biosimilars.
For more detailed information on biologics and biosimilars, a valuable resource is the FDA's official guidance on biosimilars.
