{"id":628864,"date":"2024-07-08T14:03:38","date_gmt":"2024-07-08T18:03:38","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=628864"},"modified":"2025-01-03T13:44:33","modified_gmt":"2025-01-03T18:44:33","slug":"is-dupixent-covered-by-medicare","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/is-dupixent-covered-by-medicare\/","title":{"rendered":"Is Dupixent covered by Medicare?"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/prescription\/dupixent\/what-is\"><span style=\"font-weight: 400;\">Dupixent<\/span><\/a><span style=\"font-weight: 400;\"> (dupilumab) is a brand-name medication that has been approved by the Food and Drug Administration (FDA) to treat the following conditions:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Moderate-to-severe atopic dermatitis (the most common type of eczema) in adults and children 6 months and older<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Moderate to severe eosinophilic asthma or asthma that is dependent on oral steroid medications in adults and children 6 years and older\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chronic rhinosinusitis with nasal polyps in adults 18 years and older<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prurigo nodularis in adults 18 years and older<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/blog\/dupixent-for-eoe\/\"><span style=\"font-weight: 400;\">Eosinophilic esophagitis (EoE)<\/span><\/a><span style=\"font-weight: 400;\"> in adults and children 1 year and older<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Dupixent works by stopping the action of substances in the body that cause inflammation.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cDupixent is considered a biologic medication, which means that it is designed to target very specific molecules within a certain pathway,\u201d\u00a0 said <\/span><a href=\"https:\/\/www.linkedin.com\/in\/gina-coscia-a6a55144\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Gina Coscia, MD<\/span><\/a><span style=\"font-weight: 400;\">, attending physician in the Division of Allergy\/Immunology at Northwell Health Physician Partners in Great Neck, New York. \u201cDupixent targets one part of the allergic inflammatory pathway and dampens that allergic response. It is a very specific but expensive therapy.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">With the cost of Dupixent averaging $5,000 per month, people rely on prescription drug coverage to make the drug affordable. Thankfully, Medicare Part D plans are likely to cover Dupixent, but coverage ultimately depends on the details of the plan.\u00a0<\/span><\/p>\n<h2 id=\"how-much-does-dupixent-cost-without-insurance\"><span style=\"font-weight: 400;\">How much does Dupixent cost without insurance?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If your healthcare provider prescribes Dupixent, what you will pay depends on a variety of factors, such as whether you have insurance. And if you\u2019re paying out of pocket, without insurance, the price you pay also depends on the pharmacy that fills your prescription. The price for the same drug can vary greatly between pharmacies, even in the same city. At the time this article was written, the <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/dupixent#coupon-prices\"><span style=\"font-weight: 400;\">average retail price of Dupixent<\/span><\/a><span style=\"font-weight: 400;\"> was $5,282.39 for a month\u2019s supply, which is two 2-milliliter prefilled syringes.\u00a0<\/span><\/p>\n<h2 id=\"does-medicare-cover-dupixent\"><span style=\"font-weight: 400;\">Does Medicare cover Dupixent?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Each Medicare Part D plan has its own list of approved prescription medications. This list is known as a formulary. \u201cA person must have one or more of certain conditions in order for Medicare to cover Dupixent,\u201d Dr. Coscia said. \u201cIt is generally reserved for patients who have what is considered uncontrolled moderate to severe disease.\u201d In other words, it must be considered medically necessary.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Even if your insurance covers Dupixent, your insurance provider may require your healthcare provider to submit additional medical information, such as other treatments you have tried\u2014a process known as step therapy. Or prior authorization may be required.<\/span><\/p>\n<h3 id=\"is-dupixent-covered-by-medicare-part-b\"><span style=\"font-weight: 400;\">Is Dupixent covered by Medicare Part B?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Prescription drug coverage through Medicare can be a little confusing. In a very general sense, Medicare A and B cover doctor\u2019s visits and hospital stays. <\/span><a href=\"https:\/\/www.medicare.gov\/coverage\/prescription-drugs-outpatient\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Medicare Part B also covers a limited number of prescription drugs<\/span><\/a><span style=\"font-weight: 400;\">, but these covered drugs are generally ones that you would not typically give to yourself, such as infusions that you get in a doctor\u2019s office, <\/span><a href=\"https:\/\/www.medicare.gov\/coverage\/flu-shots\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">flu shots<\/span><\/a><span style=\"font-weight: 400;\">, and vaccines. Dupixent is not covered under Medicare Part B.<\/span><\/p>\n<h3 id=\"is-dupixent-covered-by-medicare-part-d\"><span style=\"font-weight: 400;\">Is Dupixent covered by Medicare Part D?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Medicare Part D plans will cover Dupixent if it is prescribed for an FDA-approved indication. Keep in mind, however, that Medicare Part D plans vary, just like commercial health insurance plans. So, your coverage may be different from someone else\u2019s. Coverage also depends on the phase of Medicare coverage you\u2019re in. <\/span><\/p>\n<h2 id=\"cost-of-dupixent-with-medicare\"><span style=\"font-weight: 400;\">Cost of Dupixent with Medicare<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Your monthly cost for Dupixent can vary quite a bit. <\/span><a href=\"https:\/\/www.dupixent.com\/support-savings\/cost-insurance\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">According to the manufacturers of Dupixent<\/span><\/a><span style=\"font-weight: 400;\">, around 79% of people with Medicare Part D can expect to pay $100 or less per month for Dupixent, and 21% of people with Medicare Part D may pay more than $100 per month.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Your monthly cost for your prescription drugs can change during the year. For instance, you might pay more at the beginning of the year or more later in the year, depending on which phase of the Part D plan you are in. Whether you have met your deductible and whether your insurance provider considers the medication to be preferred or not preferred are other factors affecting how much you will pay. The cost you will pay is also impacted by whether you qualify for and enroll in Extra Help, a federal low-income subsidy that helps lower Part D costs.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Assuming Dupixent is on your Medicare Part D formulary\u2014a list of prescription drugs it covers\u2014there may be policies your doctor and you must follow before the drug is approved. For example, your Medicare Part D plan administrator may require your healthcare provider to prove that the drug is medically necessary through a process called <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><span style=\"font-weight: 400;\">prior authorization<\/span><\/a><span style=\"font-weight: 400;\">. They may also require <\/span><a href=\"https:\/\/rarediseases.org\/policy-issues\/step-therapy\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">step therapy<\/span><\/a><span style=\"font-weight: 400;\">, which involves trying other less expensive medications before Dupixent.<\/span><\/p>\n<h2 id=\"how-to-save-on-dupixent\"><span style=\"font-weight: 400;\">How to save on Dupixent<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">You may be able to make Dupixent more affordable with the<\/span> <a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><span style=\"font-weight: 400;\">SingleCare prescription discount card<\/span><\/a><span style=\"font-weight: 400;\">. It\u2019s free to use, and it provides access to Dupixent coupons at more than 35,000 participating pharmacies around the country. With a SingleCare discount, you could pay $3,603 for a month\u2019s supply instead of $5,149.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you have Medicare Part D coverage but can\u2019t afford your prescriptions, you can apply for the Social Security Administration\u2019s <\/span><a href=\"https:\/\/www.medicare.gov\/basics\/costs\/help\/drug-costs\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Medicare Extra Help<\/span><\/a><span style=\"font-weight: 400;\"> program. Medicare beneficiaries can <\/span><a href=\"https:\/\/secure.ssa.gov\/i1020\/Ee006bView.action\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">apply for Extra Help<\/span><\/a><span style=\"font-weight: 400;\"> anytime for help with costs like deductibles, premiums, and copays for prescription drugs, even if they\u2019ve already enrolled in a Medicare Part D plan.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are other <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/how-to-save-on-dupixent\/\"><span style=\"font-weight: 400;\">ways to save on Dupixent<\/span><\/a><span style=\"font-weight: 400;\"> as well, including the <\/span><a href=\"https:\/\/www.dupixent.com\/support-savings\/copay-card\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Dupixent MyWay copay card<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.dupixent.com\/support-savings\/dupixent-my-way\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">the <\/span><span style=\"font-weight: 400;\">Dupixent MyWay patient assistance program<\/span><\/a><span style=\"font-weight: 400;\">. Call DUPIXENT MyWay at 844-DUPIXENT (844-387-4936) to see if you meet the eligibility requirements.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dupixent (dupilumab) is a brand-name medication that has been approved by the Food and Drug Administration (FDA) to treat the following conditions: Moderate-to-severe atopic dermatitis (the most common type of eczema) in adults and children 6 months and older Moderate to severe eosinophilic asthma or asthma that is dependent on oral steroid medications in adults [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":628866,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[4343,15],"coauthors":[21058],"class_list":["post-628864","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-brand-name-drugs","tag-medicare","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Is Dupixent covered by Medicare?<\/title>\n<meta name=\"description\" content=\"Medicare Part D plans are likely to cover Dupixent for uncontrolled cases of moderate to severe atopic dermatitis and other FDA-approved indications.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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