In the sto­ry law­mak­ers and drug pric­ing re­form ad­vo­cates have told about the drug in­dus­try, there are per­haps few greater vil­lains than Hu­mi­ra and its mak­er Ab­b­Vie.

Eliz­a­beth War­ren 

Be­tween 2012 and 2018, Ab­b­Vie upped the drug’s an­nu­al af­ter-re­bates cost from $19,000 to $38,000 in the US, with stick­er prices now over $60,000 per year — in­creas­es that led to ac­cu­sa­tions of price goug­ing, most re­cent­ly from De­mo­c­ra­t­ic pres­i­den­tial fron­trun­ner Eliz­a­beth War­ren.

“Hu­mi­ra is used by mil­lions of pa­tients around the world to treat dis­eases like arthri­tis, pso­ri­a­sis, and Crohn’s dis­ease,” War­ren tweet­ed Sat­ur­day as part of a thread on drug prices. “But its man­u­fac­tur­er, Ab­b­Vie, dou­bled its price—and used bla­tant­ly an­ti-com­pet­i­tive be­hav­ior to pre­vent a com­peti­tor from en­ter­ing the mar­ket.”

But mas­sive drug pric­ing bill or not, that re­al­i­ty will change in 2023 when sev­er­al biosim­i­lars are set to come to mar­ket. An­oth­er one just of­fi­cial­ly joined the list as Pfiz­er earned the FDA nod for its biosim­i­lar, ABRI­LA­DA.

Along with sev­er­al oth­er com­pa­nies, Pfiz­er was sued by Ab­b­Vie as the old Amer­i­can phar­ma de­vel­oped their ri­val drug — a not un­com­mon move in the biosim­i­lar world. Pfiz­er set­tled last year. Like Am­gen, My­lan, Sam­sung Bioepis, San­doz, Fre­se­nius Kabi, and Mo­men­ta all did, they agreed to roll out their biosim­i­lar in 2023.

At the time Boehringer In­gel­heim was the last hold­out, telling The Cen­ter for Biosim­i­lars “we are com­mit­ted to mak­ing it avail­able to US pa­tients as soon as pos­si­ble, and cer­tain­ly be­fore 2023.” They signed an agree­ment in May to re­lease their drug, Cyl­te­zo, in 2023.

Pfiz­er billed the news as an op­por­tu­ni­ty to help pa­tients in the long list of in­di­ca­tions that have made Hu­mi­ra a block­buster: rheuma­toid arthri­tis, ju­ve­nile id­io­path­ic arthri­tis, pso­ri­at­ic arthri­tis, anky­los­ing spondyli­tis, adult Crohn’s dis­ease, ul­cer­a­tive col­i­tis and plaque pso­ri­a­sis. The FDA tout­ed the move as the 25th ever biosim­i­lar ap­proval and the 9th this year.

The wide in­di­ca­tion has led to huge rev­enues for Ab­b­vie — $3.89 bil­lion in Q3 2019 alone — and im­proved qual­i­ty of life for many pa­tients, but the high prices have led to sto­ries of pa­tients stag­ger­ing dos­es to man­age the cost.

“Dur­ing the hol­i­days, I was con­tem­plat­ing what am I’m go­ing to do,” one 51-year-old woman with col­i­tis and Chron’s dis­ease told The New York Times last year. “I was think­ing should I just go on a liq­uid di­et, be­cause I can’t af­ford this.”

Com­pe­ti­tion should send the prices down when the biosim­i­lars roll­out. Eight are to be re­leased that year un­der set­tle­ments with Ab­b­Vie, be­gin­ning with Am­gen’s Am­je­vi­ta on Jan­u­ary 31st. Not all have been FDA ap­proved yet.

Pfiz­er will be the last to join the par­ty, with their roll­out date sched­uled for No­vem­ber 20, 2023. They have yet to gain EMA ap­proval but can mar­ket the drug in Eu­rope the mo­ment they pass that hur­dle.

Ab­b­Vie, though, is not yet out of the woods. Short­ly af­ter Boehringer set­tled the last of the in­tel­lec­tu­al prop­er­ty rights cas­es, a class ac­tion suit was lodged al­leg­ing Ab­b­Vie used its “patent thick­et” to cre­ate an il­le­gal mo­nop­oly and that Ab­b­Vie col­lud­ed with the biosim­i­lar com­peti­tors to di­vide the mar­ket.

Steve Holtzman was awoken by a 1 a.m. call from a doctor at Duke University asking if he could put some pigs on a plane and fly them from Ohio to North Carolina that day. A motorcyclist had gotten into a horrific crash, the doctor explained. He believed the pigs’ livers, sutured onto the patient’s skin like an external filter, might be able to tide the young man over until a donor liver became available.

David Livingston, the Dana-Farber/Harvard Med scientist who helped shine a light on some of the key molecular drivers of breast and ovarian cancer, died unexpectedly last Sunday.

One of the senior leaders at Dana-Farber during his nearly half century of work there, Livingston was credited with shedding light on the genes that regulate cell growth, with insights into inherited BRCA1 and BRCA2 mutations that helped lay the scientific foundation for targeted therapies and earlier detection that have transformed the field.