Does Medicaid cover Trelegy Ellipta?

In this article:

• Does Medicaid cover Trelegy Ellipta?
• Factors influencing Medicaid coverage for Trelegy Ellipta
• How to get discounts on Trelegy without Medicaid

In this article

• Does Medicaid cover Trelegy Ellipta?
• Factors influencing Medicaid coverage for Trelegy Ellipta
• How to get discounts on Trelegy without Medicaid

Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol) is a prescription medication used to treat chronic obstructive pulmonary disorder (COPD), which can involve emphysema, chronic bronchitis, or both. It is also prescribed for maintenance treatment of asthma in adults. Trelegy is a combination of three long-acting medicines in one inhaler, making it easier for patients to take their medication. Trelegy can be expensive without insurance or discounts, which is why many patients rely on some form of coverage, whether it’s private insurance, Medicare, or Medicaid.

Does Medicaid cover Trelegy Ellipta?

Medicaid usually covers Trelegy, but coverage ultimately depends on your plan and state of residence. All states currently provide some form of coverage for outpatient drugs.

According to GSK, the manufacturer of Trelegy Ellipta, most Medicaid beneficiaries pay $5–$10 per month for their medication. The best way to find out whether your state’s Medicaid plan covers Trelegy and learn how much it will cost you out of pocket is to contact your state’s Medicaid agency. If you have a managed Medicaid plan, you could contact the plan that administers your benefits. 

Factors influencing Medicaid coverage for Trelegy Ellipta

The price you pay for Trelegy Ellipta with Medicaid, your drug copay, depends on the details of your specific state plan. 

For example, Medicaid programs may use drug utilization management techniques, sometimes known as restrictions. An example of one such technique is the act of encouraging states to omit high-cost drugs from their prescription drug formularies. Or, they may approve them if lower-cost alternatives are ineffective. This is called step therapy.

Another example of a drug utilization management technique is requiring prior authorization before covering the drug. Prior authorization is a standard process among health insurance companies, including Medicaid. It essentially involves ensuring that prescribed treatments are medically necessary. If your state Medicaid program requires prior authorization for Trelegy Ellipta, it will coordinate coverage with your healthcare provider, who will be asked to show that a particular medication is medically necessary. This process may take time, so be sure to allow two to 10 business days, or even more in some cases, for Medicaid to approve coverage of Trelegy Ellipta.

How much does Trelegy cost without insurance?

The average retail price for Trelegy Ellipta is $917 per aerosol powder inhaler. But that doesn’t mean you’ll necessarily pay that price. Drug prices fluctuate and vary by pharmacy and location. 

How to get discounts on Trelegy without Medicaid

There are ways to save on Trelegy Ellipta if you don’t have Medicaid or if it isn’t on your Medicaid plan’s formulary. For example, with a SingleCare prescription discount card, you can access online coupons that you can use at participating pharmacies around the country to save hundreds of dollars on your prescription, as well as refills. With a SingleCare coupon for Trelegy, you could pay $534 instead of $917 per Trelegy Ellipta inhaler. This saves you $383 per month—and $4,596 per year.

If you find that you simply cannot afford Trelegy, or if it isn’t on your Medicaid plan’s preferred drug list, talk with your healthcare provider about Trelegy alternatives. They may be able to prescribe an alternative, such as Advair Diskus, Symbicort, Breo Ellipta, Dulera, or Anoro Ellipta instead of Trelegy to help you manage your COPD or asthma symptoms instead of Trelegy. Janet M. O’Mahony, MD, a Baltimore-area internal medicine physician with Mercy Medical Center in Baltimore, Maryland, recommends always letting your healthcare provider know if the medication they prescribe you is too expensive. “You want to see if there is a more affordable solution rather than stopping the medication and going without.”