{"id":630331,"date":"2024-11-08T11:53:16","date_gmt":"2024-11-08T16:53:16","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=630331"},"modified":"2026-01-02T15:21:48","modified_gmt":"2026-01-02T20:21:48","slug":"does-medicaid-cover-dupixent","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicaid-cover-dupixent\/","title":{"rendered":"Does Medicaid cover Dupixent?"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/prescription\/dupixent\/what-is\"><span style=\"font-weight: 400;\">Dupixent (dupilumab)<\/span><\/a><span style=\"font-weight: 400;\"> is a prescription, injectable medication that <\/span><span style=\"font-weight: 400;\">targets specific proteins in the body that trigger inflammation, helping reduce symptoms and improving the quality of life for those with <\/span><span style=\"font-weight: 400;\">chronic inflammatory conditions. Dupixent was <\/span><a href=\"https:\/\/www.regeneron.com\/downloads\/dupixent_fpi.pdf\"><span style=\"font-weight: 400;\">approved by the Food and Drug Administration (FDA)<\/span><\/a><span style=\"font-weight: 400;\"> to treat atopic dermatitis (eczema), asthma, prurigo nodularis, <\/span><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;\">, chronic sinusitis with nasal polyps, and chronic obstructive pulmonary disease (COPD).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Without insurance, Dupixent can be difficult for people to afford. However, Medicaid might help cover the cost. Since Medicaid rules can differ, it\u2019s important to understand how the program works and become familiar with your Medicaid plan details and drug formulary.<\/span><\/p>\n<h2 id=\"does-medicaid-cover-dupixent\"><span style=\"font-weight: 400;\">Does Medicaid cover Dupixent?\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Yes, Medicaid may cover Dupixent, but coverage is dependent on where you live and on specific criteria that need to be met. Medicaid is a program funded by both the federal government and individual states, and each state has its own list of drugs (formulary) that Medicaid will pay for. Dupixent might be on your state\u2019s formulary, but it\u2019s essential to check with your local Medicaid program. If your state requires you to enroll in a managed Medicaid plan, you will need to check the specific plan\u2019s formulary, as it may vary from other plans.<\/span><\/p>\n<h3 id=\"factors-influencing-medicaid-coverage-for-dupixent\"><span style=\"font-weight: 400;\">Factors influencing Medicaid coverage for Dupixent\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">If Medicaid covers Dupixent in your state, there might be specific requirements you need to meet:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Diagnosis:<\/b><span style=\"font-weight: 400;\"> You will likely need a confirmed diagnosis of the condition Dupixent is FDA approved to treat, like eczema or asthma.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Previous treatments:<\/b><span style=\"font-weight: 400;\"> Some states might require you to try less expensive treatments before Medicaid approves Dupixent. This is called <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/step-therapy\/\"><span style=\"font-weight: 400;\">step therapy<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Prior authorization:<\/b><span style=\"font-weight: 400;\"> Your healthcare provider might need to get Medicaid <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><span style=\"font-weight: 400;\">approval before<\/span><\/a><span style=\"font-weight: 400;\"> you can start using Dupixent. This process involves submitting details about your medical history and why Dupixent is necessary.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Income level:<\/b><span style=\"font-weight: 400;\"> Your eligibility for Medicaid and how much coverage you get for Dupixent may also depend on your income level. Each state has income limits that determine whether you qualify for Medicaid benefits. Income level may also impact how much of a copay or coinsurance you\u2019ll have to pay for prescription drugs.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">For example, <\/span><a href=\"https:\/\/www.forwardhealth.wi.gov\/WIPortal\/Subsystem\/KW\/Print.aspx?ia=1&amp;p=1&amp;sa=48&amp;s=3&amp;c=345&amp;nt=Immunomodulators,%20Atopic%20Dermatitis&amp;adv=Y\"><span style=\"font-weight: 400;\">Wisconsin Medicaid\u2019s preferred drug list<\/span><\/a><span style=\"font-weight: 400;\"> considers Dupixent a nonpreferred drug that requires prior authorization. Additionally, the condition Dupixent is being used to treat must be FDA approved, and patients must meet the age requirements for each FDA-approved condition. For moderate to severe atopic dermatitis, for instance, the healthcare provider has to prove that the beneficiary has had a recent adverse history with a medium-potency topical <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/corticosteroids\"><span style=\"font-weight: 400;\">corticosteroid<\/span><\/a><span style=\"font-weight: 400;\">. The beneficiary also has to be between 6 months and 11 years old. If they\u2019re 12 or older, they have to have tried a drug called Adbry first.\u00a0<\/span><\/p>\n<h2 id=\"how-much-does-dupixent-cost\"><span style=\"font-weight: 400;\">How much does Dupixent cost?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Without insurance or Medicaid, Dupixent costs an average of $5,339 for 2, 2 mL pens, which is typically a 30-day supply. The price varies, though, and most people don\u2019t pay that price.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Several factors can affect the cost of Dupixent:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Dosage:<\/b><span style=\"font-weight: 400;\"> The cost may change based on how much you need, depending on what condition you\u2019re treating and how your body responds to the medicine.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Pharmacy:<\/b><span style=\"font-weight: 400;\"> Prices vary between pharmacies, so checking different places for the best price is a good idea. You can do this online by looking up any medication on <\/span><a href=\"https:\/\/www.singlecare.com\/drug-price-look-up-tool\"><span style=\"font-weight: 400;\">SingleCare\u2019s drug price lookup tool<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Location:<\/b><span style=\"font-weight: 400;\"> Drug prices are higher in some cities than others\u2014even cities within the same state.\u00a0<\/span><\/li>\n<\/ul>\n<h3 id=\"cost-of-dupixent-with-medicaid\"><span style=\"font-weight: 400;\">Cost of Dupixent with Medicaid<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The cost of Dupixent with Medicaid will depend on your state\u2019s specific Medicaid plan. Medicaid usually helps lower the cost of prescription drugs, but you might still have some out-of-pocket expenses, such as:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Copays:<\/b><span style=\"font-weight: 400;\"> Some states require a small copayment for each prescription. This amount is usually low compared to the total price of the medicine. According to <\/span><a href=\"https:\/\/www.dupixent.com\/support-savings\/cost-insurance\"><span style=\"font-weight: 400;\">Sanofi and Regeneron Pharmaceuticals, Inc.<\/span><\/a><span style=\"font-weight: 400;\">, Dupixent\u2019s manufacturer, Medicaid patients often pay about $4\u2013$9 per month.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Coinsurance:<\/b><span style=\"font-weight: 400;\"> Sometimes, you might need to pay a percentage of the cost of the medicine. This percentage may depend on where you live, among other factors.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">To determine what you might need to pay, check your state\u2019s Medicaid drug list or contact your local Medicaid office.<\/span><\/p>\n<h2 id=\"how-to-get-dupixent-with-medicaid\"><span style=\"font-weight: 400;\">How to get Dupixent with Medicaid<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you qualify for Medicaid and need Dupixent, follow these steps:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Talk to your healthcare provider. <\/b><span style=\"font-weight: 400;\">If your healthcare provider thinks Dupixent is worth trying for your condition, they\u2019ll write a prescription.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Wait for any prior authorization requirements.<\/b><span style=\"font-weight: 400;\"> If your state\u2019s Medicaid program requires prior authorization, your healthcare provider must send the necessary paperwork to Medicaid. This could take about a week.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Fill the prescription:<\/b> <a href=\"https:\/\/www.singlecare.com\/blog\/how-to-get-dupixent-specialty-pharmacy-considerations\/\"><span style=\"font-weight: 400;\">Dupixent has to be filled by a specialty pharmacy<\/span><\/a><span style=\"font-weight: 400;\">, and Medicaid may have its own specialty pharmacy that it requires you to use for Dupixent. Once your healthcare provider sends your prescription to the pharmacy, the pharmacy will either have it delivered to your home or to your healthcare provider\u2019s office, where they will teach you how to inject it.\u00a0<\/span><\/li>\n<\/ol>\n<h2 id=\"ways-to-get-discounts-on-dupixent-without-medicaid\"><span style=\"font-weight: 400;\">Ways to get discounts on Dupixent without Medicaid<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you don\u2019t have Medicaid or if your state doesn\u2019t cover Dupixent, there are still ways to save on the medicine. For example, <\/span><span style=\"font-weight: 400;\">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;\"> provides digital coupons you can use at thousands of participating pharmacies. With a <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/dupixent\"><span style=\"font-weight: 400;\">Dupixent coupon from SingleCare<\/span><\/a><span style=\"font-weight: 400;\">, you may pay $4,030 instead of $5,339 for two autoinjector pens.\u00a0<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/how-to-save-on-dupixent\/\"><b>How to save on Dupixent<\/b><\/a><\/p>\n<p><span style=\"font-weight: 400;\">If you can\u2019t afford Dupixent, with or without Medicaid, be sure to talk to your healthcare provider. They may be able to recommend more affordable <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/dupixent-alternatives\/\"><span style=\"font-weight: 400;\">Dupixent alternatives<\/span><\/a><span style=\"font-weight: 400;\"> to help manage your symptoms.\u00a0<\/span><\/p>\n<p><small><em> The SingleCare prices in this article are the most accurate at the time of publishing in ZIP code 23666 as of Jan. 2, 2026. Prices vary by pharmacy. Visit our <a href=\"https:\/\/www.singlecare.com\/prescription\/dupixent\">Dupixent coupon page<\/a> for updated Dupixent prices near you.<\/em><small><\/small><\/small><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dupixent (dupilumab) is a prescription, injectable medication that targets specific proteins in the body that trigger inflammation, helping reduce symptoms and improving the quality of life for those with chronic inflammatory conditions. Dupixent was approved by the Food and Drug Administration (FDA) to treat atopic dermatitis (eczema), asthma, prurigo nodularis, eosinophilic esophagitis (EoE), chronic sinusitis [&hellip;]<\/p>\n","protected":false},"author":149,"featured_media":630332,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[15103,16],"coauthors":[21032],"class_list":["post-630331","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-drug-pricing","tag-medicaid","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>Does Medicaid cover Dupixent?<\/title>\n<meta name=\"description\" content=\"Medicaid covers Dupixent in some cases, but it depends on where you live, your specific needs, and your state\u2019s approval processes. 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