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Is Otezla covered by insurance? | How much does Otezla cost without insurance? | How to get Otezla without insurance
Otezla (apremilast) is a brand-name prescription drug that treats active psoriatic arthritis, moderate to severe plaque psoriasis, and oral ulcers due to Behcet’s disease. Belonging to a group of drugs called disease-modifying anti-rheumatic drugs (DMARDs), Otezla prevents psoriasis symptoms by blocking the immune system. People prescribed Otezla take one 30 mg tablet twice per day except in the first five days of treatment when titrating the dose. Otezla is an expensive brand-name drug with no generic or over-the-counter versions, but people without health insurance do have options that can help make treatment more affordable.
RELATED: Otezla side effects
Is Otezla covered by insurance?
Many commercial health insurance plans provide coverage for Otezla but may require prior authorization or that other drugs be tried first. According to Amgen, the manufacturer of Otezla, about 2/3 of people with commercial health insurance have preferred coverage for Otezla without having to take other DMARDs first. People on Medicare or Medicaid may or may not have Otezla coverage and are encouraged to contact Amgen for assistance. Some insurance companies may specify a particular specialty pharmacy to fill the prescription.
How much does Otezla cost without insurance?
The average cost for a 30-day supply of Otezla tablets (30, 30 mg tablets) is $5,760 for people paying the full retail price. Without insurance coverage, then, a year of treatment could add up to $70,000.
Many people with commercial health insurance coverage who use an Otezla copay card from Amgen, can pay $0 per month. Otezla copay cards, however, cannot be used with government-subsidized insurance such as Medicare Part D, Medicaid, or the VA. In those cases, the out-of-pocket cost will depend on the health plan’s deductible, co-insurance, or co-payment.
Otezla is the only FDA-approved psoriasis drug belonging to a class of prescription medications called PDE-4 inhibitors, a family of drugs that work by blocking a specific step in the inflammatory process. There are no other brand-name or generic alternatives that work like Otezla used to treat psoriasis.
People who can’t afford Otezla may be able to afford drugs that also block the immune system, called “disease-modifying” drugs (DMARDs). Some, like monoclonal antibody injections, are more expensive than Otezla. More traditional DMARDs, however, are available as generic drugs and are more affordable. For moderate to severe plaque psoriasis, commonly used traditional DMARDs are methotrexate, cyclosporine, and acitretin. For moderate to severe psoriatic arthritis, the most commonly used traditional DMARDs are methotrexate, cyclosporine, Azulfidine (sulfasalazine), Arava (leflunomide), and Azasan (azathioprine). However, they may not be as effective as Otezla for some people, and the possible side effects may be different.
Although healthcare professionals may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) or other over-the-counter medications to treat symptoms of plaque psoriasis or psoriatic arthritis, there are no over-the-counter drugs, dietary supplements, or natural remedies that can effectively prevent or roll back more severe cases of these conditions.
| Compare Otezla prices to related drugs | |||
|---|---|---|---|
| Drug name | Price without insurance of brand-name drug | SingleCare price | Savings options |
| Otezla | $5,760 per 60, 30 mg tablets | $3,064 per 60, 30 mg tablets of brand-name Otezla | See updated prices |
| Trexall (methotrexate) | $168 for 4, 10 mg tablets | $7 for 16, 2.5 mg tablets of generic Trexall | See updated prices |
| Neoral (cyclosporine) | $94 per 30, 25 mg capsules | $8 per 30, 25 mg capsules of generic Neoral | See updated prices |
| Soriatane | $855 per 30, 10 mg capsules | $131 per 30, 10 mg capsules of generic acitretin | See updated prices |
| Azulfidine (sulfasalazine) | $335 per 120, 500 mg tablets | $8 per 120, 500 mg tablets of generic Azulfidine | See updated prices |
| Arava | $1,549 per 30, 20 mg tablets | $26 per 30, 20 mg tablets of generic Arava | See updated prices |
| Azasan (azathioprine) | $323 per 30, 100 mg tablets | $38 per 30, 100 mg tablets of generic Azasan | See updated prices |
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs. The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see updated drug prices.
How to get Otezla without insurance
With an annual cost of close to $70,000, Otezla may be hard to fit into most people’s budgets without some outside help. Health insurance helps, but not everyone with insurance will have their claim readily approved. Patient assistance programs and manufacturer coupons will be able to help people who meet the eligibility requirements, but not everyone is eligible. There are, however, several more surefire ways to make Otezla affordable, starting with a SingleCare prescription discount card.
1. Use a SingleCare savings card
With a free coupon from SingleCare, people can immediately save as much as $2,700 off the average retail price of Otezla. Visit the Otezla coupon page to choose your savings based either on discount price or participating pharmacy.
2. Ask for a free Otezla starter pack from the prescriber
The prescribing healthcare provider could have free Otezla starter packs that contain the appropriate doses for the first 14 days of Otezla treatment. Fourteen days doesn’t sound like much but it does represent almost $3,000 in savings. It also provides a chance to explore other options.
3. Shop for health insurance
In the long run, the most solid way to afford Otezla treatment is to have health insurance. When you add up premiums, co-insurance, deductibles, and copay costs, the monthly cost of an insurance policy will most certainly be substantially lower than the $7,000 monthly cost of Otezla. Remember: even with health insurance coverage, it may be hard to get an Otezla prescription approved. Before buying a policy, consult an agent to make sure the policy will cover Otezla.
4. Enroll in Medicaid
If, when you add everything up, health insurance is still unaffordable, consider Medicaid health insurance. Subsidized by the government, Medicaid insurance plans have low premiums and low out-of-pocket costs. Visit your state’s Medicaid website for eligibility guidelines and enrollment forms. As before, people with Medicaid health insurance may have difficulty getting approval for Otezla. Make sure to consult an agent to help find a plan that will cover Otezla.
5. Get medical advice about switching to traditional DMARDs
If funding cannot be found, it may be necessary to switch to lower-cost generic drugs. Called “traditional DMARDs” by healthcare professionals, these drugs are not only more affordable, it’s easier to find help paying for them. There may be trade-offs. Their common side effects may differ, and they may not work as well as Otezla. Discuss these trade-offs and safety information with a healthcare professional before giving up on Otezla.
