Abbvie names Magellan, EmpiRx, and CapRx in amended filing targeting employer health plans use of financial assistance programs.
AbbVie is the manufacturer for the world’s most profitable drug of all time: Humira. Taking in over $200B in revenue with a >50% profit margin.
Long the thorn for employer health plans, Humira’s pre rebate cost is nearly $85k/year per patient.
Humira enjoyed monopoly status for two decades as AbbVie leveraged the court system to extend their patent protection and make deals with competitors to keep competing products off the shelves
The lawsuit brought by AbbVie targets PBMs and little known companies that exploit alternative funding arrangements for financial gain.
AbbVie, like many manufacturers offers financial aid for uninsured and underinsured patients.
Payer Matrix is one of those entities. We’ve seen contracts from PM that charge 27% of the savings for their assistance leveraging these financial aid programs.
Those savings fees rarely take into account the after rebate drug cost.
Thus, an employer can end up paying PM $22k for getting one patient their Humira for free through AbbVie’s assistance program.
PM isn’t alone in this game. Others like SHARx, ScriptSourcing, and even PBMs have gotten in the game. ScriptSourcing used to charge a 50% savings fee - I have the receipts.
Now AbbVie is crying fowl. Alleging racketeering and naming EmpiRx, Capital Rx, and Magellan PBMs as co-conspirators milking these programs and taking away funds from those in need.
These programs are opportunistic no doubt but it’s hard to sympathize with AbbVie who’s played the system better than anyone who’s come before. Remember: one drug, $200 Billion.
Now it’s off patent. Biosimilars are easily available for $800/month or less.
But Abbvie just moved the puck. Their focus is now on maximizing revenue on Skirizi and Rinvoq which come with even higher price tags.
It’s hard to argue that anyone can afford an $80k a year drug (or even $50k post rebate) when median household income is in the $50k range
So who should pay? Who can pay?
“It is amazing that people who think we cannot afford to pay for doctors, hospitals, and medication somehow think that we can afford to pay for doctors, hospitals, medication, and a government bureaucracy to administer it.”
-Dr. Thomas Sowell
