For many years, Humira (adalimumab) was one of the world's best-selling and most expensive drugs, with an annual list price often approaching $90,000. The expiration of its primary patents has since paved the way for competition from several biosimilar drugs, including Hyrimoz (adalimumab-adaz), which launched in the U.S. in 2023. As a biosimilar, Hyrimoz was proven to be highly similar to Humira in safety, effectiveness, and quality, offering patients an equally viable treatment option. For millions of patients suffering from conditions like rheumatoid arthritis, Crohn's disease, and plaque psoriasis, the entry of Hyrimoz into the market has created a crucial opportunity for cost savings.
The two-tiered pricing strategy: branded vs. unbranded Hyrimoz
To compete with the established market dominance of Humira, biosimilar manufacturers have adopted creative pricing strategies. In the case of Hyrimoz, maker Sandoz, and its partner Cordavis (a CVS Health subsidiary), have utilized a dual-pricing approach for their adalimumab product. This strategy significantly complicates a simple cost comparison but provides patients and insurers with options.
- High-list-price Hyrimoz: A branded version of Hyrimoz was initially launched with a list price only slightly lower than Humira's. This version exists primarily to compete for rebates on insurance formularies, similar to how traditional branded drugs operate.
- Low-list-price unbranded adalimumab: The same medication is also available under an unbranded name, adalimumab-adaz. This version has a dramatically lower list price—often around 80% or more off Humira's price—and is targeted at the cash-paying market or plans that favor lower-priced medications. For instance, a version of Hyrimoz marketed by Cordavis has been reported to cost about $1,400 a month compared to Humira's $7,000.
This pricing nuance means that whether Hyrimoz is cheaper depends on which version a patient receives and how their insurance plan is structured. The potential for cost savings is substantial, but patients must navigate this new pricing landscape with their doctors and pharmacists.
The role of Pharmacy Benefit Managers (PBMs) in cost
Pharmacy Benefit Managers, such as CVS Caremark, play a significant role in determining a patient's final out-of-pocket cost. PBMs negotiate with drug manufacturers to determine which drugs are included in an insurance plan's formulary. Traditionally, they have favored higher-list-price drugs in exchange for rebates, which may not always translate into lower patient costs.
However, the recent Humira biosimilar market has shifted this dynamic. In a key move, CVS launched its subsidiary, Cordavis, to partner with Sandoz and promote the low-priced Hyrimoz. This allowed CVS Caremark to prioritize the more affordable biosimilar on its formularies, potentially benefiting patients and health plans. This dynamic shows that a drug's list price is not the sole factor determining access or cost—PBM strategies are critical as well.
Comparing Humira and Hyrimoz for cost and coverage
Here is a comparison of Humira and Hyrimoz, illustrating the factors that influence patient costs.
| Feature | Humira | Hyrimoz (Branded) | Hyrimoz (Unbranded/Low List Price) |
|---|---|---|---|
| Drug Type | Original Biologic | Biosimilar | Biosimilar |
| Active Ingredient | Adalimumab | Adalimumab-adaz | Adalimumab-adaz |
| Manufacturer | AbbVie | Sandoz | Sandoz (often via a partner like Cordavis) |
| List Price | Very High (e.g., $7,000+/month) | High (slightly lower than Humira) | Significantly lower (e.g., ~$1,400/month) |
| Effectiveness/Safety | N/A (benchmark) | Highly similar to Humira | Highly similar to Humira |
| Insurance Coverage | Widespread but with high rebates | Depends on formulary negotiations | Depends on formulary strategy; often preferred |
| Patient Savings | myAbbVie Assist program | Sandoz One Source co-pay card | Sandoz One Source co-pay card, potentially lower cash prices |
How to reduce your out-of-pocket expenses
Regardless of which medication you are prescribed, there are concrete steps patients can take to manage their costs:
- Verify your insurance coverage: Your plan's formulary dictates which adalimumab product is covered, and at what tier. Your out-of-pocket cost can vary dramatically depending on whether a biosimilar is a preferred medication.
- Utilize manufacturer programs: Both AbbVie and Sandoz offer robust patient assistance programs. myAbbVie Assist helps qualifying patients with Humira, while Sandoz One Source provides financial support and co-pay cards for Hyrimoz.
- Explore discount cards: Services like GoodRx can provide significant discounts on the cash price of low-cost adalimumab products. These may be beneficial if you are uninsured or have a high deductible.
- Discuss options with your doctor: Your healthcare provider can help you understand the therapeutic equivalence of biosimilars and may be able to prescribe a lower-cost alternative based on your health plan's formulary. It is essential not to switch medications without your doctor's guidance.
The long-term impact of biosimilars
The introduction of biosimilars like Hyrimoz is a significant development in the broader pharmaceutical market. The competition they introduce has already forced the prices of originator biologics down, benefiting the healthcare system as a whole. This pressure on pricing will likely lead to greater affordability and access to life-changing medications for many patients suffering from chronic autoimmune diseases. For the individual patient, the key takeaway is that the pricing landscape for adalimumab has changed, creating more opportunities for savings, but requiring proactive research and discussion with healthcare providers.
Conclusion
In short, Hyrimoz is indeed typically much cheaper than Humira, but the exact cost savings for a patient are dependent on a complex interplay of pricing strategies, insurance plan dynamics, and available financial assistance programs. For patients with autoimmune conditions, understanding the difference between the high-list-price branded version and the low-list-price unbranded version is crucial. By working with their healthcare team and leveraging available resources, patients can find the most cost-effective and clinically appropriate adalimumab treatment for their needs. The increasing competition from biosimilars represents a positive step toward greater affordability in specialty medication markets.
