Just as a reminder, Medicare’s negotiated price for Stelara is $4,695 per 30-day supply. That is a 66% discount from the wholesale acquisition cost (WAC). The current discount for biosimilar ustekinumab is 85% to 92%, yielding prices of $1500–$2,300 per month. Johnson and Johnson, Stelara’s manufacturer, wishes its lowest net price was $4,700 per month! Compared with biosimilar competition, the negotiated Medicare maximum fair price (MFP) in 2026 is a bad deal. But anyone familiar with the biosimilar industry and its track record understood this when ustekinumab showed up on the Centers for Medicare and Medicaid Services’ list of drug targets.
In the case of Enbrel, the story is a bit more complex, especially from the biosimilar manufacturer’s point of view. Biosimilar competition for the etanercept category will not occur for at least 2 years after the Medicare MFP is implemented in 2026. That price is $2,355 per month, or a 67% discount from Amgen’s WAC for Enbrel. The Colorado Prescription Drug Affordability Board has decided to establish an upper payment limit for what it pays for Enbrel, “at $583.59 per unit, which is the current Maximum Fair Price for Enbrel.” This is the cost per weekly dose.
There are only two FDA-approved etanercept biosimilars today, and it is unclear whether both (or either) will launch when they are finally permitted to, after 30 years of exclusivity. Yet, the degree to which biosimilar competition will reduce the price in 2028/2029 from what will be a 67% WAC-discounted baseline is unclear. This may be one case where the biosimilar savings may be limited, as Amgen reported 10% lower net sales worldwide based on $3.29 billion in US (only $28 million in ex-US sales). If the Medicare MFP is instituted by Colorado and other states in January 2026, and then by private payers as a reference price, expect this net sales figure to be perhaps below $1 billion by the time Erelzi or Eticovo are launched in the US. Whatever biosimilar savings accrue for etanercept will therefore be minimal; most of the savings will obtained before the biosimilars are even marketed.