OBJECTIVES: Brazilian private health insurances (PHIs) are required to provide coverage for biological drugs of intravenous (IV) and subcutaneous (SC) administration for the treatment of rheumatoid arthritis (RA). This study aims to compare the annual treatment cost of the biological drugs approved for RA in Brazil. METHODS: The Brazilian Society of Rheumatology (SBR) consensus for RA treatment in Brazil recommends the initiation of biological treatment with TNF inhibitors or abatacept (ABT) or tocilizumab (TCZ). Upon failure, the switch to a second TNF inhibitor is recommended or to ABT, TCZ, rituximab (RTX) or still tofacitinib (TOFA), a non-biological drug with no mandatory coverage. Annual treatment costs were calculated for the two treatment lines for a patient of 70 kg, following doses/intervals defined in the products labels. Only drug acquisition costs were considered and prices were gathered from the official price list. Deterministic sensitivity analysis (DSA) was carried to determine the impact of weight parameter on results. RESULTS: Golimumab (GOL) presents the second lowest annual treatment cost in first line treatment at R$38,212/patient/year. Two alternative treatment options can present annual costs twice as higher: adalimumab (R$85,807) and etanercept (R$77,998); TCZ is 25% higher (R$49,041) and ABT is 50% higher (R$58,484). In second line, the same results are found, with annual cost of TOFA 44% superior to GOL at R$55,260. DSA results reveal that annual cost with ABT, infliximab (IFX) and TCZ can be as high as ADA and ETN ones assuming a patient of 110 kg. CONCLUSIONS: One of the most efficient treatment alternatives for RA management, GOL shows to be an option of great value to PHIs managers. Treatment with GOL can bring savings up to 50% to PHIs, with the convenience of a once a month SC dosage.