Enbrel, a biologic marketed by Amgen, is the most prescribed medication
21 In 2014 alone, Amgen’s Enbrel sales totaled $4.4 billion.
who take Enbrel will not be surprised by the large sums the drug brings in for
its manufacturer; after all, an Enbrel prescription could “cost over $1,000
under a high-deductible plan.”
23 Moreover, Enbrel’s discount card is not
available for anyone on Medicare or Medicaid.
24 This is particularly difficult
for RA patients, as “[a] substantial number of rheumatoid arthritis patients
are Medicare enrollees, and many struggle to afford any type of self-injectable biologic because of the significant copays . . . .”
Biosimilars are poised to shake up the American pharmaceutical market:
they are generally cheaper than biologics and are anticipated to lower costs,
Prohibiting Insurance Discrimination Against Victims of Domestic Violence, 23 AM. U. J.
GENDER, SOC. POL’Y & L. 413, 423 (2015) (commenting that the Affordable Care Act
(“ACA”) requires that insurance companies cover patients who have preexisting conditions;
before the ACA, a preexisting conditions could preclude someone from insurance coverage);
Nadja Popovich et al., Here’s How ‘Obamacare’ Covered Americans with Pre-Existing
Conditions. What Happens Next?, GUARDIAN (Jan. 26, 2017),
healthcare-preexisting-conditions (listing RA and Lupus as preexisting conditions likely to
result in coverage denial before the ACA).
21. What Results Could I Expect with ENBREL?, AMGEN,
https://www.enbrel.com/rheumatoid-arthritis/ra-enbrel-treatment-results/ (last visited Apr. 9,
22. Carly Helfand, Big Question for Pfizer: Will Enbrel’s EU Biosim Bring on the Pain?,
FIERCEPHARMA (Jan. 19, 2016, 11: 34 AM), http://www.fiercepharma.com/sales-and-marketing/big-question-for-pfizer-will-enbrel-s-eu-biosim-bring-on-pain.
23. CONSUMER REPORTS, supra note 4 (noting that some biologics cost more than $5,000
per week); Jack Hoadley et al., It Pays to Shop: Variation in Out-of-Pocket Costs for Medicare
Part D Enrollees in 2016, HENRY J. KAISER FAM. FOUND. (Dec. 2, 2015), http://kff.org/report-section/it-pays-to-shop-variation-in-out-of-pocket-costs-for-medicare-part-d-enrollees-in-
2016-findings/ (noting that Medicare Part D enrollees pay approximately $4,872 per year out
of pocket for Enbrel); Alison Kodjak, Specialty Drugs Can Prove Expensive Even with
Medicare Coverage, NAT’L PUB. RADIO (Dec. 3, 2015, 10: 20 AM),
expensive-even-with-medicare-coverage (“The out-of-pocket cost for Enbrel, a rheumatoid
arthritis medicine, for example, could reach almost $50,000 a year, if it’s not covered.”); Adam
Rubenfire, Rheumatoid Arthritis Drug Prices on the Rise, MODERN HEALTHCARE (Apr. 1,
2016), http://www.modernhealthcare.com/article/20160401/NEWS/160409993 (explaining
that RA drugs are often placed on a specialty tier, “which increases the patient’s cost-sharing
responsibilities.” “The wholesale cost of Enbrel . . . has increased 80.3% since 2013, and now
exceeds $4,000 for a 30-day supply . . . .”); PEW CHARITABLE TRUSTS, SPECIALTY DRUGS AND
HEALTH CARE COSTS (2015), http://www.pewtrusts.org/~/media/assets/2015/11/specialty-
drugs-and-health-care-costs_artfinal.pdf (“[P]atients who need specialty drugs face higher
out-of-pocket (OOP) costs, because health plans often require a co-insurance payment, which
is a set percentage of a drug’s price. Some plans charge a co-insurance as high as 33 percent.”).
24. Co-Pay, Cost, and Coverage: See How We Can Help, AMGEN,
https://www.enbrel.com/support/financial-assistance/ (last visited Apr. 9, 2017) (indicating
people with commercial or private insurance may be eligible for the ENBREL Support Co-Pay Card; people with Medicare or Medicaid may qualify for a low-income subsidy).