{"id":631307,"date":"2025-02-10T16:21:11","date_gmt":"2025-02-10T21:21:11","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=631307"},"modified":"2026-01-07T13:21:37","modified_gmt":"2026-01-07T18:21:37","slug":"is-breztri-covered-by-medicaid","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/is-breztri-covered-by-medicaid\/","title":{"rendered":"Is Breztri covered by Medicaid?"},"content":{"rendered":"

For many people, breathing is second nature. But for people with chronic obstructive pulmonary disease (COPD), it\u2019s not nearly as easy. That\u2019s where <\/span>Breztri Aerosphere<\/span><\/a> comes in. This three-in-one inhaler combines a corticosteroid (<\/span>budesonide<\/span><\/a>), an anticholinergic (<\/span>glycopyrrolate<\/span><\/a>), and a long-acting beta2-adrenergic agonist (<\/span>formoterol fumarate<\/span><\/a>) to improve breathing and reduce COPD flare-up symptoms.<\/span><\/p>\n

It\u2019s a powerful medication, but that power can come at a cost. And while the specific price depends on several factors, it may leave patients wondering if they\u2019ll get any help from Medicaid. Usually, yes, although the out-of-pocket costs can vary. Here are all the important details.\u00a0\u00a0\u00a0<\/span><\/p>\n

Does Medicaid cover Breztri?<\/span><\/h2>\n

Most of the time, Medicaid will cover Breztri. But since Medicaid is jointly funded by the state and federal governments, each state has different policies and eligibility requirements. Typically, patients have to meet certain household income requirements, but the exact amounts can vary by state.<\/span><\/p>\n

Factors influencing Medicaid coverage of Breztri\u00a0<\/span><\/h2>\n

There are two major factors that determine whether a Medicaid plan will cover Breztri: the preferred drug list (PDL) and prior authorization requirements.<\/span><\/p>\n

Preferred drug list<\/span><\/h3>\n

Even though most Medicaid beneficiaries will get at least some coverage for Breztri, it may depend on where you live. Each state has a Preferred Drug List (PDL), which shows how its Medicaid plans will cover different prescription drugs.<\/span><\/p>\n

These lists typically categorize drugs as preferred or nonpreferred, and they can vary in how they classify Breztri. Some states may have budget restrictions, so they might prioritize covering cheaper alternatives. However, Breztri does not have a cheaper generic alternative, so some states may list it as a preferred drug. Some states might also have <\/span>quantity limits<\/span><\/a>, which restrict the amount of medication a patient can get in a certain time frame.\u00a0<\/span><\/p>\n

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

Sometimes, insurance plans require additional steps before approving coverage, to ensure a certain drug is medically necessary\u2014a process called <\/span>prior authorization<\/span><\/a>. \u201cFor Breztri, prior authorization usually requires showing that the medication is medically necessary. Medicaid often asks for evidence such as recent pulmonary function tests to confirm moderate to severe COPD,\u201d says <\/span>Michael Genovese, MD, JD<\/span><\/a>, chief medical adviser at <\/span>Ascendant New York<\/span><\/a>. \u201cAdditionally, doctors typically need to document that the patient has tried other therapies\u2014like long-acting bronchodilators or inhaled corticosteroids\u2014and explain why those treatments weren\u2019t effective or caused side effects.\u201d\u00a0<\/span><\/p>\n

The process of trying other medications first is called step therapy, and some plans require it. For example, one of Dr. Genovese\u2019s patients had severe COPD and needed Breztri, \u201cbut faced delays because Medicaid required proof that other treatments had been tried and failed,\u201d he says. \u201cWe had to submit detailed documentation, including medical records, test results, and notes about the patient\u2019s symptoms and responses to previous medications.\u201d<\/span><\/p>\n

COPD Coupons & Resources<\/a><\/p>\n

But prior authorization can move smoothly if the patient and healthcare provider communicate well. Dr. Genovese says he always advises patients to stay proactive. \u201cEnsure your healthcare provider knows your medication history, including any past prescriptions that didn\u2019t work for you,\u201d he says. \u201cKeep your records organized and readily available. Following up with your healthcare provider\u2019s office or Medicaid representative can help prevent unnecessary delays.\u201d<\/span><\/p>\n

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

When <\/span>paying for Breztri without insurance<\/span><\/a>, Medicare, or Medicaid coverage, the average price is $918 for an inhaler with a 30-day supply of medication. <\/span><\/p>\n

That price may change, though, depending on your dosage and pharmacy. Drug prices between pharmacies, even ones in the same community, can vary by potentially hundreds of dollars.<\/span><\/p>\n

Costs of Breztri with Medicaid<\/span><\/h3>\n

Once again, Breztri\u2019s specific out-of-pocket cost is based on how much a particular Medicaid plan will cover. That said, \u201cfor Medicaid beneficiaries, Breztri is often very affordable,\u201d Dr. Genovese says. In fact, AstraZeneca, the <\/span>manufacturer of Breztri<\/span><\/a>, says most people with Medicaid will pay $0.99\u2013$1.38 per month, and \u201csome states may even waive copays entirely for certain beneficiaries. Reviewing your specific Medicaid plan to understand your exact out-of-pocket costs is essential.\u201d<\/span><\/p>\n

For example, for people enrolled in Michigan\u2019s Medicaid fee-for-service plan, pharmacy copays are $1 for preferred drugs and $3 for nonpreferred drugs. <\/span>Breztri is nonpreferred<\/span><\/a> and requires prior authorization for coverage, but beneficiaries who are dually eligible for Medicare and Medicaid are exempt from these fees. <\/span>The state\u2019s Department of Health and Human Services notes<\/span><\/a>, however, that some Medicaid health plan copays may differ.<\/span><\/p>\n

That\u2019s just one example, and there are 49 other states that may handle Breztri coverage differently, so be sure to check your formulary for details.<\/span><\/p>\n

Ways to get discounts on Breztri<\/span><\/h2>\n

Not everyone pays full price for Breztri Aerosphere. One of the easiest and most effective <\/span>ways to save on Breztri<\/span><\/a> is to use a SingleCare coupon. It\u2019s free to <\/span>sign up for a SingleCare prescription discount card<\/span><\/a> and access coupons you can use at local participating pharmacies. However, you can\u2019t use SingleCare coupons on top of Medicaid coverage.<\/span><\/p>\n

Patients can also apply for discounts directly from Breztri\u2019s manufacturer, AstraZeneca. If you have private insurance that doesn’t cover Breztri\u2019s full cost, you might be eligible for Breztri Zero Pay, which might reduce out-of-pocket costs to as low as $0 per month. However, you can\u2019t enroll if you receive prescription drug coverage from any government-sponsored programs, including Medicare and Medicaid. If you\u2019re uninsured or have Medicare or Medicaid and need additional help paying for Breztri, you may be eligible for AstraZeneca\u2019s broader patient assistance program, AZ&Me.<\/span><\/p>\n

Additionally, \u201cIf your healthcare provider approves, ask about a 90-day prescription,\u201d Dr. Genovese recommends. \u201cPharmacies often offer discounts on larger quantities, reducing the per-month cost.\u201d It might also be worth calling around to local pharmacies to find the lowest prices on Breztri, since prices can vary significantly between them.<\/span><\/p>\n

The SingleCare prices in this article are the most accurate at the time of publishing in ZIP code 23666 as of Jan.7, 2026. Prices vary by pharmacy. Visit our <\/span><\/i>Breztri coupon page<\/span><\/i><\/a> for updated Breztri prices near you.<\/span><\/i><\/small><\/small><\/p>\n","protected":false},"excerpt":{"rendered":"

For many people, breathing is second nature. But for people with chronic obstructive pulmonary disease (COPD), it\u2019s not nearly as easy. That\u2019s where Breztri Aerosphere comes in. This three-in-one inhaler combines a corticosteroid (budesonide), an anticholinergic (glycopyrrolate), and a long-acting beta2-adrenergic agonist (formoterol fumarate) to improve breathing and reduce COPD flare-up symptoms. It\u2019s a powerful […]<\/p>\n","protected":false},"author":15,"featured_media":631308,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[20946,15103,16],"coauthors":[8861],"class_list":["post-631307","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-copd","tag-drug-pricing","tag-medicaid","wpautop"],"acf":[],"yoast_head":"\nIs Breztri covered by Medicaid?<\/title>\n<meta name=\"description\" content=\"Most state Medicaid plans cover Breztri Aerosphere for COPD, but coverage varies by state.\" \/>\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-breztri-covered-by-medicaid\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" 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