{"id":629223,"date":"2024-08-03T12:10:56","date_gmt":"2024-08-03T16:10:56","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=629223"},"modified":"2025-12-30T12:37:40","modified_gmt":"2025-12-30T17:37:40","slug":"is-fasenra-covered-by-medicare","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/is-fasenra-covered-by-medicare\/","title":{"rendered":"Is Fasenra covered by Medicare?"},"content":{"rendered":"

The ability to breathe easily is something people may take for granted, but not people with severe <\/span>eosinophilic asthma<\/span><\/a>. This occurs when a certain type of white blood cells, called eosinophils, cause inflammation in the airways, impeding lung function. Often prescribed alongside systemic corticosteroids, <\/span>Fasenra<\/span><\/a> (benralizumab) is an injectable biologic medication that <\/span>targets and eliminates those white blood cells<\/span><\/a>. But like many biologics, its initial prices can seem daunting.<\/span><\/p>\n

The exact amount you pay for Fasenra depends on factors such as where you purchase it and what your insurance covers. Medicare will often cover at least part of Fasenra\u2019s costs under Part B or Part D, but it depends on the plan and where the drug is administered, whether in a healthcare provider\u2019s office or at home.<\/span><\/p>\n

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

Insurance can significantly reduce Fasenra\u2019s out-of-pocket expenses, but for people paying entirely out of pocket, it can be costly. According to AstraZeneca, the manufacturer of Fasenra, its list price is $5,845 per 30 mg\/mL pen. However, your pharmacy may charge more, as prices vary by pharmacy. You\u2019ll pay less if your insurance or Medicare covers it.<\/span><\/p>\n

Your prescribed dosage will affect how much you pay for Fasenra per year, as pediatric dosage differs from adult dosage. For adults, \u201cit is injected under the skin once per month for three months, and then once every two months after that,\u201d says <\/span>Tanya Feke, MD,<\/span><\/a> a health policy analyst. If you were to pay the list price, that could amount to close to $50,000 per year.<\/span><\/p>\n

Not everyone pays that price. Aside from Medicare, Medicaid, and insurance coverage, there are a few other factors that can influence it. For example, <\/span>prices can vary between pharmacies<\/span><\/a> since each pharmacy sets its own prices based on how much they pay for the drug, their overhead costs, and other circumstances.<\/span><\/p>\n

Biologic drugs like Fasenra often cost more than other drugs because of their unique development and complex structure. Unlike many medicines, which are chemically synthesized, biologics are created from <\/span>living cells<\/span><\/a>\u2014a costly and time-consuming process. Some biologics have <\/span>biosimilars<\/span><\/a>, which are more affordable alternatives to brand-name biologics and can cost much less. Unfortunately, Fasenra doesn\u2019t yet have a direct biosimilar substitute, and \u201cwith a patent that will not expire until 2033, the cost is unlikely to decrease anytime soon,\u201d Dr. Feke says.<\/span><\/p>\n

Does Medicare cover Fasenra?<\/span><\/h2>\n

Yes, many Medicare plans may cover part of Fasenra treatment. How much they will cover varies based on the specific insurance provider and policy. Which part of Medicare provides this coverage depends on whether a healthcare professional administers the injection in their office or the patient administers it at home.<\/span><\/p>\n

However, some drug plans may require the prescribing healthcare provider to verify Fasenra\u2019s medical necessity first, according to <\/span>Ojas Doshi<\/span><\/a>, a product development scientist in the pharmaceutical industry. \u201cThis primarily means that the patient has been diagnosed with severe eosinophilic asthma, which has responded insufficiently to conventional therapies.\u201d This process is called <\/span>prior authorization<\/span><\/a>. If a particular plan requires it, \u201cthe healthcare provider will need to submit medical records for the patient that include the patient’s diagnosis, description of previous treatments, and why Fasenra is being recommended,\u201d Doshi says. Some plans may also require patients to try other medications first, a restriction known as step therapy.<\/span><\/p>\n

Is Fasenra covered by Medicare Part B?<\/span><\/h3>\n

\u201cFasenra is one of the few medications that can be covered by either Medicare Part B or Medicare Part D. You will need to reach out to your healthcare provider to see if they offer it under Part B,\u201d Dr. Feke says.<\/span><\/p>\n

Medicare Part B handles outpatient medical services, office visits, home health care, and more. That\u2019s why \u201cMedicare Part B generally covers biologic treatments like Fasenra when administered in a healthcare setting, such as a doctor’s office or hospital,\u201d says <\/span>Sazan Sylejmani<\/span><\/a>, Pharm.D. \u201cThis is because these medications are typically considered durable medical equipment (DME) by Medicare.\u201d <\/span>Medicare data shows<\/span><\/a> that, in 2022, Part B plans covered nearly $217 million of Fasenra on over 45,000 claims.<\/span><\/p>\n

Is Fasenra covered by Medicare Part D?<\/span><\/h3>\n

\u201cWhen Fasenra is approved for administration by the patient at home (which is not the norm), it becomes a Part D benefit,\u201d Doshi says. \u201cThe patient would pick up the medication at a pharmacy.\u201d In these cases, the healthcare provider typically provides training or instructions for use. Since Part D comprises standalone outpatient drug plans that beneficiaries can add to their Medicare Part A and Part B policies, some people might have both Part B and Part D. <\/span>Part D plans covered around $119 million<\/span><\/a> worth of Fasenra pens (the at-home injector) in 2022, as well as over $65 million in regular Fasenra.<\/span><\/p>\n

Cost of Fasenra with Medicare<\/span><\/h2>\n

Once again, what you pay depends on which part of Medicare covers your treatment. People who have coverage under Medicare Part B and no supplemental plan will have to pay <\/span>a 20% coinsurance<\/span><\/a> for Fasenra.\u00a0\u00a0<\/span><\/p>\n

According to <\/span>AstraZeneca<\/span><\/a>, patients with Medicare Advantage plans (Part C), which often include Part D, pay an average of $90 per dose. But that depends entirely on the specific plan.\u00a0<\/span><\/p>\n

How to save on Fasenra<\/span><\/h2>\n

There are <\/span>ways to save on Fasenra<\/span><\/a>, although not all are available to Medicare beneficiaries. Here are a few you can consider if your Medicare plan won\u2019t cover Fasenra or if your out-of-pocket costs with Medicare are too high.<\/span><\/p>\n

    \n
  1. Sign up for a free SingleCare prescription discount card. <\/b>By working directly with over 35,000 pharmacies, SingleCare has secured discounts on thousands of medications. Everyone is eligible for a <\/span>SingleCare card<\/span><\/a>, even if they have Medicare. Just know that you can\u2019t use these discounts on top of Medicare coverage.\u00a0<\/span>Your healthcare provider may have Fasenra in their office, or they may have to order it from a specialty pharmacy, which will deliver it either to your healthcare provider or to your home (if you\u2019re self-administering the Fasenra pen).\u00a0\u00a0<\/span><\/li>\n
  2. Apply for Fasenra patient assistance. AstraZeneca has a program called AZ&Me that\u2019s specifically for uninsured individuals and people who have Medicare but still need help paying for their medications. AstraZeneca says the program is a last-resort option, and that all Medicare beneficiaries with specialty and rare diseases who meet program eligibility requirements must exhaust other avenues of assistance before enrolling.\u00a0 <\/span><\/b><\/li>\n
  3. Look into Medicare Extra Help.<\/b> A Medicare program called <\/span>Extra Help<\/span><\/a> can help eligible beneficiaries pay for Fasenra if it is being covered under Part D or the prescription portion of Medicare Advantage. If eligible, you could pay $0 for your Medicare premiums, have no deductible, and pay just $12.65 for brand-name prescriptions like Fasenra. Anyone who gets accepted for Medicaid is automatically enrolled in Extra Help.\u00a0<\/span><\/li>\n
  4. Look into a Medicare Savings Program<\/b>. A Medicare Savings Program administered by your state may help offset certain Part B costs. In some instances, this may include premiums, deductibles, or coinsurance. Contact your local state Medicaid office for details and to apply. <\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    The ability to breathe easily is something people may take for granted, but not people with severe eosinophilic asthma. This occurs when a certain type of white blood cells, called eosinophils, cause inflammation in the airways, impeding lung function. Often prescribed alongside systemic corticosteroids, Fasenra (benralizumab) is an injectable biologic medication that targets and eliminates […]<\/p>\n","protected":false},"author":15,"featured_media":629224,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[15103,15],"coauthors":[8861],"class_list":["post-629223","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-drug-pricing","tag-medicare","wpautop"],"acf":[],"yoast_head":"\nIs Fasenra covered by Medicare?<\/title>\n<meta name=\"description\" content=\"Medicare will often cover Fasenra under Part B or Part D, but the coverage amount depends on the plan and where the drug is administered.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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