What is the most expensive drug for rheumatoid arthritis?

October 6, 2025 •

4 min read

According to a 2024 report, Humira was the costliest drug for self-funded plans in 2023. For many patients, the answer to what is the most expensive drug for rheumatoid arthritis lies within the class of high-cost biologic medications and advanced targeted therapies, which can cost tens of thousands of dollars annually without insurance.

Quick Summary

The most expensive rheumatoid arthritis treatments are biologic drugs like Humira, Enbrel, and Remicade, which are costly due to complex manufacturing and market factors. Patient costs are influenced by insurance plan specifics, including high coinsurance, specialty tiers, and prior authorization rules. The introduction of biosimilars offers alternatives, but doesn't guarantee significantly lower out-of-pocket expenses for everyone.

Key Points

Leading Expensive RA Drug: While prices fluctuate, Humira (adalimumab) has consistently been one of the most expensive rheumatoid arthritis drugs, with list prices for a monthly supply exceeding $8,000 without insurance.
Biologics are the Cost Drivers: The highest-cost RA medications are biologics like Humira, Enbrel, and Remicade, which are expensive to develop and manufacture using living cells.
Insurance Affects Out-of-Pocket Costs: Even with insurance, patients can face high costs due to specialty drug tiers, high coinsurance, and administrative hurdles like prior authorization and step therapy.
Biosimilars Offer Alternatives: The introduction of biosimilars for drugs like Humira can provide lower list price options, but actual patient cost savings depend heavily on their specific insurance plan.
Annual Costs Can be Significant: For RA patients, annual medication costs for these advanced therapies can reach tens of thousands of dollars, making insurance and patient assistance programs critical.
Consult a Healthcare Provider: The best way for patients to navigate these costs is to work closely with their doctor and pharmacist to explore all options, including patient assistance programs.

The High Cost of Biologics and Advanced Therapies

For many people living with rheumatoid arthritis (RA), the financial burden of medication can be substantial. The most expensive drugs are typically advanced therapies, particularly biologics and targeted synthetic disease-modifying antirheumatic drugs (DMARDs), which have dramatically improved RA treatment but come with a high price tag. For years, the biologic drug Humira (adalimumab) has been a leading example of this trend, often cited as one of the most expensive and highest-selling drugs globally. Its cash price can run into thousands of dollars per month without insurance, and annual costs can approach $96,000.

However, Humira is not the only high-cost biologic. Other prominent and expensive RA biologics include Enbrel (etanercept) and Remicade (infliximab). Enbrel, another anti-TNF drug, has historically maintained a high price point, while Remicade, an intravenous biologic, also carries a significant cost, partly due to administration fees. In addition to biologics, targeted synthetic DMARDs like Xeljanz (tofacitinib) also have high costs, adding to the financial complexities of managing RA.

Why These Medications Command High Prices

The exorbitant cost of these drugs stems from several key factors related to their development and market dynamics:

Complex Manufacturing: Unlike traditional generic drugs synthesized from chemicals, biologics are made from living cells, a complex and expensive process that cannot be easily replicated. This makes it difficult for other companies to produce a true, chemically identical generic version when patents expire.
Research and Development Costs: The development of novel biologics and advanced therapies requires extensive research, time, and financial investment. Companies argue that high prices are necessary to recoup these development costs and fund future innovation.
Patent Exclusivity: Patents grant drug manufacturers a period of market exclusivity, during which they can set prices without competition. This period of protection significantly contributes to high drug prices in the United States.
Market-Based Pricing: The U.S. market, in particular, operates under a pricing model where pharmaceutical prices are determined by what the market will bear, rather than being linked to development costs or benchmarked to other countries.

Insurance Coverage and the Patient's Financial Burden

Even with insurance, the high list prices of these specialty drugs translate into significant out-of-pocket costs for patients. Insurance companies often place biologics on high-cost specialty drug tiers, requiring patients to pay a percentage of the drug's cost (coinsurance) rather than a fixed copayment. For a drug with a list price of $8,000 per month, a 25% coinsurance could leave a patient with a $2,000 monthly bill before reaching their deductible or out-of-pocket maximum.

Most insurers also require prior authorization, where a doctor must justify the need for a specific, expensive drug before coverage is approved. Additionally, step therapy may be mandated, which requires patients to first try and fail on a less expensive drug before the insurer will cover a costlier alternative. These policies, while intended to control costs, can delay treatment and increase financial stress for patients.

Biosimilars: An Affordable Alternative?

Biosimilars are highly similar, FDA-approved versions of biologic drugs, offering a potentially more affordable alternative. In recent years, several biosimilars for Humira have become available, including Cyltezo (adalimumab-adbm) and Amjevita (adalimumab-atto). The hope is that this competition will drive down costs, but the impact on patient out-of-pocket expenses is not always straightforward due to complex insurance plans and pharmacy benefit manager (PBM) negotiations. While biosimilars may lower the overall list price, insurance coverage structures and rebates can sometimes mean patients don't see a significant reduction in their copay or coinsurance. You can learn more about biosimilars from the Arthritis Foundation to understand how they might fit into a treatment plan and budget.

Conclusion: Navigating the Financial Side of RA Treatment

While the answer to what is the most expensive drug for rheumatoid arthritis often points to high-end biologics like Humira, the true cost for a patient is highly dependent on their insurance coverage and assistance programs. Understanding the difference between list prices and out-of-pocket costs, along with the role of insurance policies like prior authorization and step therapy, is crucial. The rise of biosimilars offers hope for more affordable options, but patients must navigate the complexities of their specific plans. Consulting with a healthcare provider and a pharmacist to explore all potential cost-saving avenues, including patient assistance programs from manufacturers, remains the best strategy for managing the financial burden of RA medications.

Cost Comparison of Common RA Medications


Feature	Humira (adalimumab)	Enbrel (etanercept)	Cyltezo (adalimumab-adbm)	Traditional DMARD (e.g., Methotrexate)
Drug Type	Biologic (anti-TNF)	Biologic (anti-TNF)	Biosimilar to Humira	Synthetic DMARD
Form	Self-injectable pen	Self-injectable pen	Self-injectable pen	Oral tablet or injection
Annual List Price (Estimate)	~ $96,000	~ $96,000	Potentially lower than Humira	Minimal (often generic)
Manufacturing	Complex, living cells	Complex, living cells	Complex, similar to biologic	Synthetic chemicals
Availability	Brand-name, many biosimilars	Brand-name (patent protected)	Biosimilar for Humira	Generic and brand-name
Notes	Highly effective, but expensive. Many biosimilars now available.	Long-standing, effective treatment. Currently faces fewer direct US biosimilar competitors than Humira.	Interchangeable biosimilar. Potential for cost savings, but varies by insurance.	Standard first-line therapy. Significantly cheaper.

Factors Influencing Patient Drug Costs

Insurance Plan Formulary: The specific list of drugs covered by an insurance plan and their respective cost tiers. Biologics are almost always in high-cost tiers.
Patient Assistance Programs: Most manufacturers of expensive biologics offer programs to help eligible patients with high out-of-pocket costs.
Prior Authorization: Insurers require doctors to obtain approval before covering expensive specialty drugs, potentially causing treatment delays.
Step Therapy: An insurer may require a patient to try and fail a less expensive medication before authorizing a costlier one.
Biosimilar Availability: The entry of biosimilars creates potential for competition and lower list prices, though patient savings can vary based on insurance rebates and formulary placement.

Frequently Asked Questions

Biologic drugs are complex medications made from living cells, unlike traditional drugs made with chemicals. The research, development, and manufacturing processes for biologics are highly complex and expensive, which contributes to their high cost.

You can check your insurance plan's formulary, which is the list of covered drugs. Biologics and other specialty drugs are typically listed on the highest cost-sharing tiers, but speaking with your doctor or pharmacist is the best way to understand your specific coverage and potential out-of-pocket costs.

A biosimilar, which is a highly similar version of a biologic, generally has a lower list price. However, whether you save money depends on your insurance. Some plans may require high coinsurance or offer lower rebates, meaning the out-of-pocket cost might not be significantly lower for you.

Prior authorization is a requirement from your insurance company that your doctor obtain approval before they will cover a specific drug. For expensive RA drugs, insurers want to ensure the medication is medically necessary and sometimes require you to try less expensive options first.

Yes, most manufacturers of expensive biologic drugs, such as Humira and Enbrel, offer patient assistance programs. These programs can help eligible patients with commercial insurance reduce their out-of-pocket costs.

Without insurance, a biologic could cost tens of thousands of dollars per year. With insurance, your out-of-pocket expenses can still amount to hundreds or even thousands of dollars annually, depending on your plan's coinsurance, deductible, and coverage structure.

Step therapy is an insurance policy that requires you to try a less expensive, often older, medication before your insurer will cover a newer, more costly drug like a biologic. You must prove the initial medication is ineffective to progress to the next 'step' of treatment.