{"id":630062,"date":"2024-10-09T14:16:22","date_gmt":"2024-10-09T18:16:22","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=630062"},"modified":"2026-04-09T15:32:46","modified_gmt":"2026-04-09T19:32:46","slug":"does-blue-cross-blue-shield-cover-dupixent","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-blue-cross-blue-shield-cover-dupixent\/","title":{"rendered":"Does Blue Cross Blue Shield cover Dupixent?"},"content":{"rendered":"

Dupixent (dupilumab) is a brand-name monoclonal antibody drug that is approved by the Food and Drug Administration (FDA) to treat a variety of conditions. Its first approval was in 2017 for atopic dermatitis (eczema). More than 800,000 people around the world take Dupixent. Specialty drugs like Dupixent are expensive to produce, and those costs are passed to consumers paying out of pocket. Insurance often covers Dupixent, but coverage varies by plan and reason for taking. Here\u2019s everything you need to know about Blue Cross Blue Shield (BCBS) coverage for Dupixent.<\/span><\/p>\n

Does Blue Cross Blue Shield cover Dupixent?<\/span><\/h2>\n

In many cases, yes, BCBS will cover Dupixent. According to Navin Arora, DO, FAAD, founder of <\/span>Borealis Dermatology<\/span><\/a>, \u201cDupixent is usually a covered drug, as it is a one-of-a-kind medicine.\u201d In fact, the Dupixent website claims that 99% of all adult and pediatric atopic dermatitis patients with private insurance are covered. But that\u2019s not a blanket statement for every BCBS health plan, and there are a lot of them.<\/span><\/p>\n

The Blue Cross and Blue Shield Association isn\u2019t a single insurance provider. It houses <\/span>multiple separate licensees<\/span><\/a>, each for a different state and each with its own range of insurance plans. For example, if you\u2019re in Illinois, you might have insurance through Blue Cross Blue Shield of Illinois. While in California, the independent licensees of the Blue Cross are Anthem Blue Cross or Blue Shield of California.<\/span><\/p>\n

Check with your specific company to confirm your Dupixent coverage. Sometimes, coverage isn\u2019t as simple as showing your insurance card at the pharmacy. There are a few potential complications to keep in mind.<\/span><\/p>\n

Reason for prescription<\/span><\/h3>\n

Along with moderate-to-severe atopic dermatitis (eczema), Dupixent is FDA approved to treat various other conditions, including moderate to severe asthma, prurigo nodularis, eosinophilic esophagitis (EoE), chronic rhinosinusitis with nasal polyps (CRSwNP), and <\/span>chronic obstructive pulmonary disease<\/span><\/a> (COPD). However, it\u2019s shown some versatility <\/span>in recent studies<\/span><\/a>, so doctors might prescribe it <\/span>off-label<\/span><\/a> for other conditions that aren\u2019t FDA approved. The issue is that many health plans won\u2019t extend medical benefits for off-label prescriptions. Most only issue coverage for treatments approved by the FDA.<\/span><\/p>\n

Prior authorization<\/span><\/h3>\n

Before covering a particular drug, particularly expensive brand-name ones like Dupixent, insurance providers might want to confirm that it\u2019s medically necessary. This process is called <\/span>prior authorization<\/span><\/a>, and Dr. Arora says that it\u2019s often required due to the cost of the medication. However, he says that, in his experience, it ends up being approved around 95% of the time.<\/span><\/p>\n

Prior authorization might require the healthcare provider to submit documentation of your symptoms, diagnosis, specialist visits, or other information. It also might include step therapy, which requires you to try other, less expensive treatments before moving on to Dupixent.<\/span><\/p>\n

Drug tier<\/span><\/h3>\n

Every insurance plan has a drug list (<\/span>formulary<\/span><\/a>) that shows how it covers different over-the-counter and prescription drugs. These lists organize covered drugs into tiers, often with generics in tier 1 and brand-name or specialty drugs in the higher tiers. Their cost-sharing policies can vary based on the tier. Typically, the higher the tier, the more out-of-pocket costs the insured member will need to pay. Because Dupixent is a specialty drug, many formularies put it in one of the higher tiers, so it could come with higher out-of-pocket costs.<\/span><\/p>\n

Specialty drug requirements<\/span><\/h3>\n

Specialty drugs are expensive medications used to treat complex conditions. As a biologic, a drug made from living cells instead of synthetic chemicals, Dupixent carries this label. That means <\/span>you can only get it at specialty pharmacies<\/span><\/a>, and it often has a quantity limit, which restricts how much you can get at a time.<\/span><\/p>\n

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

Without insurance coverage or any other discounts, the <\/span>average cash price for Dupixent<\/span><\/a> is $5,513 for 2, 2 mL pens. Fortunately, not everyone will have to pay that amount, especially if they get some help from BCBS.<\/span><\/p>\n

But, even if your plan covers Dupixent, you\u2019ll probably still have copayments. A <\/span>2023 employer health benefits survey from KFF<\/span><\/a> showed that the average copay across insurance companies is $11 for first-tier drugs, $36 for second-tier drugs, $66 for third-tier drugs, and $125 for fourth-tier drugs.<\/span><\/p>\n

Even though you\u2019ll often find Dupixent in one of the higher tiers, Dr. Arora says he has found that copays for Dupixent range from $0\u2013$25 per month. However, they might also be a lot higher. It all depends on your plan.<\/span><\/p>\n

How much does Dupixent cost with Blue Cross Blue Shield?<\/span><\/h3>\n

It depends on your plan\u2019s cost-sharing policies and drug tiers. The developers of Dupixent, Sanofi and Regeneron Pharmaceuticals, Inc., provide some insight into Dupixent\u2019s <\/span>average costs<\/span><\/a>:<\/span><\/p>\n