TABLE 4.
Evolution of originator adalimumab (Humira®) prices (40 mg syringe or pen), presented as price before and after loss of exclusivity (up to May 10, 2019), for the different European countries surveyed. Unless indicated otherwise, the presented prices are list prices including value added tax and margins (where appropriate).
| Country | Price of originator adalimumab before loss of exclusivity | Price of originator adalimumab after loss of exclusivity |
| Albania | 2014 – March 2019: €580.25 per unit (€1,160.5 per package of 2). No confidential discounts or rebates exist. | From May 2019: €335.49 per unit (€670.98 per package of 2). No confidential discounts or rebates exist. |
| The biosimilar Hulio® is listed at €253 per unit and thus recommended as first choice. | ||
| Austria | €479.88 per unit (€959.75 per package of 2) Ex-factory price: €450 per unit (€900 per package of 2). No confidential discounts exist. |
€233.65 (€467.30 per package of 2) Ex-factory price: €213 per unit (€426 per package of 2). Further confidential discounts exist. |
| In May 2019, the least expensive biosimilar was Hulio®, with a list price of €220.13 per unit, plus a confidential rebate. | ||
| From September 2019, the price of Humira® further decreased to €199.35 per unit, plus a confidential rebate. In Austria, when a third biosimilar enters the market, all biosimilars and the originator listed in reimbursement need to adjust their price to the third biosimilar. This adjustment for all products happened in September 2019. | ||
| As of November 2019, Idacio® is the least expensive adalimumab product, listed at €199.3, plus a confidential rebate. | ||
| Belgium | February 1, 2018: €522 per unit (€1,043.75 per package of 2); €518 per unit (€3,107.47 per package of 6). | January 2019: €359 per unit (€717.74 per package of 2); €338 per unit (€2,025.86 per package of 6). |
| May 2019: €315.25 per unit (€630.5 per package of 2); €296.26 per unit (€1,777.55 per package of 6). | ||
| October 1, 2018: €518 per unit (€1,036.91 per package of 2); €515 per unit (€3,087.02 per package of 6). | Price reductions are the result of mandatory decreases. No confidential discounts or rebates exist. | |
| Humira® was included in a confidential managed entry agreement. | Biosimilars are priced somewhat lower: €291.43 per unit (€582.85 per package of 2); €288.34 per unit (€1,730.06 per package of 6). | |
| Bulgaria | Up to October 2018: €409.48 per unit (€818.95 per package of 2). Confidential discounts may apply. | List prices have been unchanged. Confidential discounts may apply. |
| The available adalimumab biosimilars have a lower price. | ||
| Croatia | From February to June 2017: €509.19 per unit. | The list price has been unchanged. |
| From July 2017 to May 2018: €502.1 per unit. | Biosimilars are listed at €412.24 per unit (Amgevita®), €371.02 per unit (Imraldi® and Hyrimoz®), and €333.92 per unit (Hulio®). | |
| From Augustus 2018 to March 2019: €484.99 per unit. | From June 2019: €333.92 per unit for the originator and biosimilars. | |
| The product was under an undisclosed managed entry agreement. | The managed entry agreement should still be in place. | |
| Cyprus | Humira® is procured by the ministry of health through public procurement. Actual prices are confidential. | Humira® is procured by the ministry of health through public procurement. Actual prices are confidential. |
| Czech rep | 2014: | Maximum price: €517.28 per unit (€1,034.55 per package of 2). |
| Maximum price: €537.57 per unit (€1,075.14 per package of 2). | Reimbursement price: €416.10 per unit (€832.19 per package of 2). | |
| Reimbursement price: €505.84 per unit (€1,011.67 per package of 2). | ||
| 2018: | From June 2019: €338.16 per unit, reimbursed up to €237.32 per unit. | |
| Maximum price: €524.90 per unit (€1,049.79 per package of 2). | ||
| Reimbursement price: €381.25 per unit (€762.49 per package of 2). | The least expensive products to use are biosimilars Amgevita® and Hulio®. Since July and August 2019, respectively, they have no co-payment. | |
| Confidential contracts can exist between hospitals and marketing authorization holders, or between health insurance companies and marketing authorization holders. | Confidential contracts can exist between hospitals and marketing authorization holders, or between health insurance companies and marketing authorization holders, for both originator and biosimilar products. | |
| Denmark | October 2018: €518.40 per unit (€1,036.79 per package of 2). | List prices for the originator have been unchanged. Discounts of more than 80% have been reported. |
| There were no additional discounts or rebates. | In a multi-winner tender two biosimilars (Imraldi®, Hyrimoz®), plus Humira®, were chosen and also one player for the pediatric form (Amgevita®). | |
| Biosimilars are listed at a lower price, but actual prices are comparable with the actual price for Humira®. | ||
| Estonia | Humira® is procured by hospitals. Prices are not known. | Humira® is, from July 2019, also available in ambulatory care: ex-pharmacy. price, including 9% VAT, of adalimumab regardless of brand name is €125.5 per unit (€251 per package of 2). |
| There are no additional discounts or rebates. | ||
| Finland | Retail price with VAT: €580 per unit (€1,160.30 per package of 2). Wholesale price: €463 per unit (€925.61 per package of 2). There were no additional discounts or rebates. |
Retail price with VAT: €412 per unit (€824.31 per package of 2). |
| For the hospital setting, actual prices are not known. | Wholesale price: €324 per unit (€647.93 per package of 2). | |
| There are no additional discounts or rebates. | ||
| The adalimumab biosimilars Amgevita® and Hulio® are the least expensive treatment options for adalimumab. | ||
| Germany | Public list price in ambulatory sector: €955.47 per unit (€1911.74 per package of 2); with parallel imports down to €871.78 per unit (€1744 per package of 2). Rebate contracts exist between the pharmaceutical company and health insurance funds. | List prices for the originator have been unchanged. Price for biosimilars is generally €572.32 per unit. Rebate contracts exist between the pharmaceutical company and health insurance funds for both originator and biosimilar products. Tenders in the hospital setting are also still operational. |
| For the hospital setting, actual prices are not known. There have been tenders (with discounts) for Humira® since at least July 2016. | ||
| Greece. | September 2018: Retail price €430.11 per syringe/€431.39 per pen; wholesale price: €368.87 per syringe/€369.97 per pen, ex-factory price €363.42 per syringe/€364.50 per pen. | May 2019: List prices have been unchanged. There is not yet a special discount. |
| For hospitals and EOPYY pharmacies, a hospital price is used that is a standard percentage of the wholesale price. | Biosimilars are listed at a lower retail price, but are not yet reimbursed: €344.59 per unit (Amgevita®), €337.84 per unit (Halimatoz®/Hefiya®/Hyrimoz®), €301.88/€269.58 per unit in package of 1/2 (Hulio®), €332.19 per unit (Imraldi®). | |
| July 2020: Confidential discounts are set for originator and biosimilar adalimumab after a negotiation procedure. | ||
| Iceland | October 2018: €525.49 per unit (€1,050.97 per package of 2); without 24% VAT: €423.78 per unit (€847.56 per package of 2). TNF-α inhibitors are purchased after a tender agreement, as is the case for all hospital medicines. No confidential discounts were offered for Humira®. |
Official list price of Humira® including VAT (24%) is €513.47 per unit (€1,026.94 per package of 2). Imraldi® and Humira® reimbursement prices are strictly confidential. The biosimilar Imraldi® is the least expensive product to use. |
| Ireland | August 2016: €656.58 to €670 per unit (€1,313.15 to €1,339.99 per package of 2) inclusive of 8% wholesaler mark-up and 23% VAT; €541.3 to €552.36 (€1,082.60 to €1,104.72 per package of 2) inclusive of 8% wholesaler mark-up, exclusive of 23% VAT. | The framework agreement between government and industry specifies at least a 20% reduction from the list price of a biological and a 12.5% rebate, which overall equates to 30% mandated reduction, following the introduction of a biosimilar onto the Irish market. This is not a commercially confidential rebate. |
| August 2018: €630.20 to €644.34 per unit (€1,260.40 to €1,288.68 per package of 2) inclusive of 8% wholesaler mark-up and 23% VAT; €519.56 to €531.21 per unit (€1,039.11 to €1,062.42 per package of 2) inclusive of 8% wholesaler mark-up, exclusive of 23% VAT. | From December 2018: €535.99 per unit (€1,071.98 per package of 2) inclusive of 8% wholesaler mark-up and 23% VAT; €441.89 per unit (€883.77 per package of 2) inclusive of 8% wholesaler mark-up, exclusive of 23% VAT. An additional 12.5% rebate is paid back to the payer by the manufacturer, i.e. €51.15 per unit. | |
| Information on discounts and/or rebates was not available. | Further confidential discounts are available for the recommended biosimilar products. As the originator was not chosen as one of the best value biologicals, it was reported that it would be unlikely that further discounts are available nationally. | |
| Italy | Since 2016, €795.8 per unit (€1,591.60 per package of 2). Ex-factory price from 2016 onwards: €318.32 per unit. |
List and ex-factory prices have been unchanged, but discounts on Humira® of 50% have been reported (based on ex-factory prices used for tendering; 80% discount when calculated against the list price). |
| Further confidential discounts existed. | Using centralized purchasing the Veneto region is paying: - Humira® (to be used only in those patients who cannot be switched to the biosimilar): €160 per unit. |
|
| - Amgevita® (winner of the bid): €98.50 per unit. | ||
| Kosovo | Humira® is not marketed in Kosovo and is also not on the national essential medicines list (NEML). However, from the group of TNF-α inhibitors, etanercept and infliximab were listed on the NEML. | Humira® is still not marketed in Kosovo and is also not on the national essential medicines list (NEML). Etanercept and infliximab were again on the NEML. |
| Latvia | Pharmacy price including VAT: €462.64 per unit, wholesale price: €410.05 per unit. | List prices have been unchanged. After the biosimilar was included in the positive list, a confidential discount was offered to lower co-payment for patients on the originator product. |
| There was a confidential discount. | The biosimilar is listed at a lower price. | |
| Lithuania | List price: €380.86 per unit (€761.72 per package of 2), reimbursement price: €378.51 per unit (€757.01 for a package of 2). | List price: €263.86 per unit (€527.71 per package of 2), reimbursement list price: €261.5 per unit (€523.00 for a package of 2). |
| There were further confidential discounts. | Confidential discounts exist. The marketing authorization holder also has the possibility to cover co-payment. | |
| From June 2018, the biosimilar should be priced 15% lower than the originator product (previously this was 30% lower for the first biosimilar, and an additional 15% for subsequent biosimilars). The biosimilar was the least expensive product. | ||
| Malta | List price: €500 per unit. There was further negotiation (result non-disclosed). | Since September 2019, Humira® is no longer procured. All patients will be switched to the biosimilar. |
| The new procurement cycle awarded adalimumab biosimilar Hulio®, listed at €237.8 per unit. | ||
| Netherlands | October 2018: €495.26 per unit (€990.51 per package of 2). The average reimbursement price to hospitals was approximately 80% of the listed price. Hospitals were expected to negotiate the difference in confidential discounts. | The list price is unchanged and is the same for biosimilars, but discounts of 80–90% have been reported for originator and biosimilar adalimumab (reducing prices to approximately €50–€100 per unit). Depending on the hospital. procurement group, either the originator or biosimilar is the least expensive product. |
| Norway | Since May 2015 to end of September 2018: €539.93 per unit (€1,079.86 per package of 2). | Now priced at €531.26 per unit (€1,062.51 per package of 2). |
| Further discounts and/or rebates occurred, but are confidential. In general, the national procurement trust in Norway is able to reduce drug prices in the hospital sector with around 30%, all over. In the field of biologicals these rebates have been even larger, but the exact rebate for Humira® is not public (as for other drugs). | There are additional discounts and/or rebates, but these are confidential. In press reports, discounts of 80% are reported. According to the tender recommendations for 2019, the originator is the least expensive product. | |
| Poland | August 2018 to February 2019: €511.81 per unit (€1,023.62 per package of 2) | March 2019 to July 2019: €302.36 per unit (€604.71 per package of 2). |
| Actual price: Approximately €389 per unit (August to October 2018). | Actual prices: €389.93 per unit (Nov/18), €387.42 per unit (Dec/18), €261.02 per unit (Jan/19), €233.57 per unit (Feb/19), €122.41 per unit (March/19). | |
| Biosimilars are listed at: €246.62 per unit (Imraldi®), €246.09 per unit (Amgevita®), €239.41 per unit (Hyrimoz®). | ||
| The actual price of Imraldi® was €112.60 per unit in Feb-March 2019. For this period very limited sales were observed (14 packages with 2 pre-filled syringes), however, actual prices for Imraldi® were only available from February 2019. | ||
| Romania | Retail price with 9% VAT: €408.19 per unit (€816.37 per package of 2); wholesale price without VAT: €370.82 per unit (€741.63 per package of 2). | Retail price with 9% VAT: €412.38 per unit (€824.75 per package of 2); wholesale price without VAT: €374.66 per unit (€749.31 per package of 2). Prices increased a little, due to the annual update with the new exchange rate. |
| No publicly-known further discounts and/or rebates existed. | The marketing authorization holder has the possibility to cover patient co-payment (which is around 26% of the retail price with VAT) through a patient access mechanism, based on an agreement implemented by an independent third party. | |
| The biosimilar Hulio® is listed at €255.04 per unit. | ||
| Russia | 2015–2018: The price for Humira® according to the essential drug list (EDL) was €479 per unit (€958 for a package of 2). | 2019: €414 per unit (€828 for a package of 2). |
| February 2018: €411.5 per unit (€823 for a package of 2). The decrease in price can be linked to the submission of the marketing authorization dossier of the biosimilar to the ministry of health. | Discounts and rebates are confidential. The final price at the retail pharmacy level ranges from €788–€1,104 for the same package; a 5% decrease or 32% increase comparing with EDL price before any mark-ups. | |
| In addition to the EDL price, there is local (regional) taxation and wholesale mark-up. Those taxation and mark-up provide up to 15–25% increase of final price at the pharmacy depending on the region, creating regional price differences. | The biosimilar (Dalibra®) is listed at a lower price, €329.25 per unit (€658.5 for a package of 2). | |
| Discounts and rebates occur at the wholesale level, but are confidential. The final price at retail pharmacy has the range €788–€1,104 for the same package. Thus a 5% decrease or 32% increase compared with the EDL price before any markps. | ||
| Scotland | €413.32 per unit (€826.64 per package of 2). | There has been no change in list price since loss of exclusivity. The actual Humira® price has significantly reduced, however, there are biosimilar products that are priced lower and therefore Health Boards are in the process of switching from Humira® to biosimilars. The detailed discounts are confidential. |
| There was a small discount available (confidential). | ||
| Serbia | In 2015 and 2016: €426.94 per unit. In 2017 and 2018: €391.05 per unit. |
In 2019: €366.71 per unit. |
| Information on discounts and/or rebates was not available. | While Humira® injections are fully reimbursed, the Humira® pen is currently not reimbursed in the Republic of Serbia. The Humira® pen was granted marketing authorization in Serbia in February 2018 and is listed at €336.18 per unit (but not reimbursed). | |
| There are additional discounts in terms of providing free-of-charge medicine for 3 months’ therapy; only for new patients eligible for therapy in the first year of therapy. This information is not publicly available. | ||
| Slovenia | In 2016: €465.55 per unit (€931.09 per package of 2). | The list price has been unchanged. |
| In 2017: €349.36 per unit (€698.71 per package of 2). | Further confidential discounts exist. | |
| Up to July 14, 2019: €335.5 per unit (€671 per package of 2). | ||
| There were additional discounts. | Biosimilars are listed at a lower price. | |
| Spain | 2012 – September 2019: €563.79 per unit. | The list price has been unchanged. |
| There were confidential discounts. | October 2019: €326 per unit (to match the reference price established in September 2019). The originator and biosimilar have the same list price as of October 1, 2019. | |
| Further confidential discounts exist. | ||
| Srpska | Actual prices under contract (Health insurance fund procurement for all hospitals):. | The current actual price is still €399.29 per unit. There are no additional discounts/rebates. |
| In 2014 and 2015: €561.46 per unit. | A decision on the choice of the best bidder is announced on the HIF website after completion of the tender procedure. | |
| In 2016 and 2017: €505.31 per unit. | Biosimilars are not yet available and reimbursed. | |
| In 2018: €479.08 per unit. | ||
| In 2019: €399.29 per unit. | ||
| Sweden | September 2018: €462.66 per unit (€925.32 per package of 2). | May 2019: €290.32 per unit. |
| A national managed entry agreement with confidential rebates exists for subcutaneous TNF-α inhibitors. | The national managed entry agreement is still in place. Different regions in Sweden currently recommend either biosimilar adalimumab or originator Humira® depending on the level of discounts and other factors. For instance, AbbVie is currently offering a mix of retroactive rebates and some adjustments of its list price to help retain market share where possible with the total discount level for Humira® remaining confidential. As a result, the Stockholm region has chosen, for the time being, to recommend continued use of Humira® as this is currently economically the most beneficial strategy for the region. |