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The global market of monoclonal antibodies (mAbs) is growing very fast. The aim of this study is to analyze the reimbursed market of adalimumab and pemborlizumab in Bulgaria. A retrospective cost analysis of the reimbursed mAbs adalimumab and pemborlizumab for ambulatory and hospital settings, respectively, paid by the National Health Insurance Fund (NHIF) was performed based on official NHIF data. The share of their costs from the total mAbs costs was calculated. The results showed that the most cost-consuming mAbs were adalimumab in ambulatory and pembrolizumab in hospital settings: 31% and 31.59% in 2020 out of the total reimbursed mAbs budget, respectively. Regardless of the extension of the reimbursed therapeutic indications, the costs for adalimumab decreased from 25,575,836.32 Euro in 2018 to 20,493,187.02 Euro in 2019 as a result of inclusion of 3 biosimilars and international price referencing. Despite the reduction of the registered price with 20%, the pembrolizumab costs have almost tripled probably because of reimbursement of five additional therapeutic indications. Overall, the reimbursed costs for pemborlizumab have been increased every year as a result of reimbursement of new therapeutic indications and increase in the number of patients treated with mAbs. The adalimumab trend is for a stable decline in the reimbursed costs because of entrance of biosimilars. [ABSTRACT FROM AUTHOR]