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Background and Importance The carbon footprint of biological drugs remains poorly documented. In situations of market exclusivity, these drugs are often associated with high costs. When competition arises, however, price differences between products may be limited. In this context, incorporating environmental impact as an additional criterion in hospital drug evaluation could provide a meaningful basis for differentiation.Aim and Objectives To evaluate the feasibility of applying life cycle assessment (LCA) to a biological drug, adalimumab, in order to estimate its carbon footprint and to explore the integration of such an approach into hospital referral decisions.Material and Methods Seven adalimumab products in prefilled pen presentations were analysed (one originator and six biosimilars, at 40 mg and 80 mg doses). The Carebone tool, developed by our institution, was used to perform a life cycle assessment including the production of the active substance, excipients, packaging materials, energy consumption during formulation and packaging, transport, and end of life of packaging. Data were collected from regulatory databases and from documentation provided by pharmaceutical companies.Results The carbon footprint of adalimumab pens varies between 515 and 1,887 grams of carbon dioxide equivalent, depending on the product and dosage, with an uncertainty rate ranging from 9% to 30%. The production of the active substance is the main source of emissions (up to 70% of the total), whereas excipients have a negligible impact. The estimates are consistent with available industrial data and with results reported for other injectable devices.Conclusion and Relevance This study provides the first comprehensive life cycle assessment of adalimumab. It confirms technical feasibility using the Carebone tool, while highlighting challenges related to the lengthy analysis time and to the collection of industrial data. It supports the inclusion of environmental criteria in the evaluation and selection of medicines in hospitals, alongside established clinical and economic considerations.References and/or Acknowledgements The authors acknowledge the contribution of the team involved in the development of the Carebone tool.Conflict of Interest No conflict of interest