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In that window, AbbVie didn’t fix tolerization.

They monetized around it.

Humira generated over $100 billion in revenue during that
protected period. And when immune rejection or patient
switching inevitably occurred, the company simply
captured that churn with Rinvoq and Skyrizi—new drugs
with new mechanisms, protected by fresh patents.

This is not a story of scientific failure. It’s a story of
commercial optimization—where patient rotation isn’t a
flaw, it’s a business model. And in that model, immune
rejection doesn’t interrupt the revenue stream.
It extends it.

Payers, too, have learned to accommodate this cycle.
Insurance companies have developed step therapy policies
that formalize switching—start here, move there if needed,
escalate if required. But rarely do those policies demand
immunologic durability as a performance metric. Coverage
decisions focus on short-term comparative efficacy, not
long-term immune harmony. And because ADA testing
isn’t mandated or consistently reimbursed, most payers
don’t track how often biologics are rejected by the immune
system—they simply authorize the next drug.

This creates a strange reality: we are paying for failure,
repeatedly, and calling it treatment.

And as long as that failure is predictable and billable, the
financial system behind biologics remains stable—even as
patient outcomes erode.

But there’s a shift coming.

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