{"id":628868,"date":"2024-07-08T14:21:27","date_gmt":"2024-07-08T18:21:27","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=628868"},"modified":"2024-12-06T12:19:24","modified_gmt":"2024-12-06T17:19:24","slug":"is-quviviq-covered-by-medicare","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/is-quviviq-covered-by-medicare\/","title":{"rendered":"Is Quviviq covered by Medicare?"},"content":{"rendered":"

Sleep can improve our mood, productivity, and overall health\u2014but for some people, catching Z\u2019s is easier said than done. Enter <\/span>Quviviq<\/span><\/a> (daridorexant), a brand-name drug approved by the Food and Drug Administration (FDA) to treat insomnia (trouble falling asleep or staying asleep). The cost of Quviviq is based on several factors, and perhaps the most influential is insurance coverage. Medicare rarely covers Quviviq, but it depends on the specific Part D plan and your reason for taking it. We\u2019ve got all the additional information you need about the medication\u2019s Medicare coverage here.\u00a0<\/span><\/p>\n

Does Medicare cover Quviviq?\u00a0<\/span><\/h2>\n

Medicare Part D plans cover plenty of prescription drugs. But unfortunately, that rarely includes Quviviq.<\/span> Ani Rostomyan, Pharm.D.<\/span><\/a>,<\/span> CEO and founder of SheAni Wellness, said, \u201cFrom my own pharmacy experience, Quviviq was not covered by my patients\u2019 Medicare part D plans.\u201d In fact, she said she only remembers one instance when an insurance provider approved a prior authorization request, and it was after a healthcare provider submitted the request on a patient\u2019s behalf based on medical necessity.<\/span><\/p>\n

These plans will sometimes cover other sleep medications, but it depends entirely on the plan. That said,<\/span> data from the Centers for Medicare & Medicaid Services<\/span><\/a> shows that Medicare Part D plans spent over $2 million covering Quviviq in 2022, so some plans may help pay in certain instances.<\/span><\/p>\n

To know for sure whether your specific plan covers Quviviq, check your plan\u2019s formulary\u2014a drug list that shows whether and how the plan covers each medication. For example, it may cover some medications entirely, while it might require beneficiaries to pay copays or coinsurance for others. And, different plans also sometimes involve various types of restrictions, such as monthly quantity limits. Every plan\u2019s formulary is different, so it\u2019s important to review yours before beginning treatment.<\/span><\/p>\n

You\u2019ll notice we didn\u2019t mention Medicare Part A or Part B, and that\u2019s because they generally don\u2019t include coverage for drugs taken outside of a hospital or doctor\u2019s office. Medicare Advantage (Part C) often comes bundled with drug coverage, but not always.<\/span><\/p>\n

Factors influencing Medicare coverage of Quviviq\u00a0<\/span><\/h2>\n

One of the biggest factors Medicare plans might take into consideration is the reason your healthcare provider prescribed Quviviq. For example, the insurance provider might see it as more necessary for someone with a diagnosed case of chronic insomnia than mild transient insomnia.\u00a0<\/span><\/p>\n

To confirm whether Quviviq is truly medically necessary, some <\/span>Medicare plans may require prior authorization<\/span><\/a> before they approve coverage. That might mean the healthcare provider has to submit paperwork confirming the patient\u2019s diagnosis, or it might mean the patient has to try less expensive medications first\u2014a process called step therapy.\u00a0<\/span><\/p>\n

How much does Quviviq cost?<\/span><\/h2>\n

So what should you expect to <\/span>pay for Quviviq<\/span><\/a> without help from Medicare or other insurance? The average cash price is $634.75 for 30, 50 mg tablets. That price stems largely from the cost required to develop new drugs. <\/span>A study from 2020 <\/span>estimated that it costs around $600 million\u2013$1.2 billion to bring a new drug to market, accounting for all research, development, and clinical trials.\u00a0<\/span><\/p>\n

Approved in 2022<\/span><\/a>, Quviviq is a relatively new drug, so \u201cits pharmaceutical company, Idorsia Pharmaceuticals, is the patent holder and has the exclusive rights to exclude others from making, using, and selling the drug,\u201d said <\/span>Tiffany Khieu, Pharm.D<\/span><\/a>, an assistant professor at <\/span>Marshall B. Ketchum University<\/span><\/a>. \u201cWhen patents expire, other companies can produce generic versions of the drug, which can influence costs,\u201d but as of right now, there\u2019s no generic version of Quviviq.<\/span><\/p>\n

That said, $634.72 is an average\u2014not a hard and fast price. The price each patient pays is subject to numerous influences. For example, prescription drug costs can vary significantly between pharmacies\u2014sometimes by hundreds of dollars\u2014since each pharmacy sets its own prices.\u00a0<\/span><\/p>\n

Cost of Quviviq with Medicare<\/span><\/h3>\n

As we mentioned, not everyone with Medicare Part D will get their Quviviq covered, but some might. Unfortunately, not all of those patients will walk away with free medications. They may still have some out-of-pocket costs (like copays and deductibles) based on their plan\u2019s cost-sharing policies. The total amount of those costs will vary, depending on the specific plan, so be sure to confirm your plan\u2019s fee structures if you receive coverage.\u00a0\u00a0<\/span><\/p>\n

Other options if Medicare doesn’t cover Quviviq<\/span><\/h2>\n

So, if Medicare and insurance companies can\u2019t help, then what? Quviviq\u2019s full price may seem intimidating, but there are several ways to save money on your prescription. Here are a few of the most reliable.<\/span><\/p>\n

1. Apply for a Quviviq copay card<\/span><\/h3>\n

Idorsia Pharmaceuticals doesn\u2019t have a patient assistance program that covers Quviviq, but it offers a discount card program called<\/span> QSavings<\/span><\/a>. People who have private health insurance plans\u2014but whose plan doesn\u2019t cover the full cost of Quviviq\u2014can use this card to get their first fill for as little as $0, then subsequent refills of a 30-day supply for as low as $25. However, it doesn\u2019t apply to uninsured patients or anyone who receives federally funded prescription drug coverage from Medicare, Medicaid, Medigap, Veterans Affairs (VA), or Department of Defense (DOD) programs.<\/span><\/p>\n

2. Get free SingleCare coupons<\/span><\/h3>\n

These discounts are available to anyone and can help decrease the price of prescription drugs at participating pharmacies. For example, a <\/span>SingleCare coupon<\/span><\/a> can reduce Quviviq\u2019s average monthly retail price from $634.75 to $488.34. You can access these discounts even if you have Medicare or insurance coverage, but you can\u2019t use both of them together.<\/span><\/p>\n

3. Consider an alternative<\/span><\/h3>\n

There\u2019s no shortage of sleep aids on the market, so if you\u2019re willing to try a different one (and your healthcare provider signs off), you\u2019ve got plenty of options. \u201cPer the <\/span>American Academy of Sleep Medicine\u2019s insomnia guidelines<\/span><\/a> for adults, there are alternatives with different mechanisms of action to treat insomnia,\u201d Dr. Khieu said. \u201cHowever, their level of evidence for efficacy is relatively weak, and benefits versus risks must be taken into consideration for each individual patient.\u201d<\/span><\/p>\n

Drugs like <\/span>Belsomra<\/span><\/a> and <\/span>Dayvigo<\/span><\/a> are also relatively new and only available in brand-name formulations, but other alternatives have been around long enough to have FDA-approved generic versions, which often come at a lower cost. For example, <\/span>zolpidem (generic Ambien)<\/span><\/a> can go for as low as $2.11 per one-month supply when you use a SingleCare coupon, depending on your choice of pharmacy. Over-the-counter supplements like melatonin, CBD, and certain vitamins might also work for some people. \u201cThere are also non-pharmaceutical options, such as <\/span>sleep hygiene<\/span><\/a>, that can improve sleep prior to medication use,\u201d Dr. Khieu said.<\/span><\/p>\n

RELATED: <\/b>Quviviq vs. Belsomra<\/b><\/a><\/p>\n

4. Research other assistance programs<\/span><\/h3>\n

Those who put in the legwork can find other assistance programs around the internet\u2014and some of the most effective come from the government and nonprofits. Medicare beneficiaries might be eligible for the <\/span>Extra Help<\/span><\/a> program, and for anyone with private insurance, the<\/span> Patient Advocate Foundation\u2019s Co-Pay Relief<\/span><\/a> program might help as well. Just know that you\u2019ll have to meet specific eligibility requirements to qualify.<\/span><\/p>\n

5. Locate cheaper pharmacy options<\/span><\/h3>\n

Driving across town isn\u2019t always the most appealing option if you\u2019ve got a jam-packed schedule, but if it can help you save on your drug costs, it might just be worthwhile. In fact, <\/span>a study from the U.S. Public Interest Research Group<\/span><\/a> found patients could save up to $5,400 per year by shopping around for the lowest price. Prices can vary by hundreds between pharmacies, even within the same vicinity, so call around to see which local pharmacy offers the best rates on Quviviq.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Sleep can improve our mood, productivity, and overall health\u2014but for some people, catching Z\u2019s is easier said than done. Enter Quviviq (daridorexant), a brand-name drug approved by the Food and Drug Administration (FDA) to treat insomnia (trouble falling asleep or staying asleep). The cost of Quviviq is based on several factors, and perhaps the most […]<\/p>\n","protected":false},"author":15,"featured_media":628869,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[4343,15],"coauthors":[8861],"class_list":["post-628868","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-brand-name-drugs","tag-medicare","wpautop"],"acf":[],"yoast_head":"\nIs Quviviq covered by Medicare?<\/title>\n<meta name=\"description\" content=\"Medicare doesn\u2019t typically cover Quviviq, but certain plans may offer some coverage, and there are ways to save.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.singlecare.com\/blog\/is-quviviq-covered-by-medicare\/\" \/>\n<meta property=\"og:locale\" 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