Is Dupixent covered by Medicare?

Understanding Medicare Coverage for Dupixent

Dupixent (dupilumab) is a biologic medication approved by the Food and Drug Administration (FDA) to treat several conditions. Here’s what you need to know about its uses, costs, and Medicare coverage.

Conditions Treated by Dupixent

Dupixent is used to treat:

• Moderate-to-severe atopic dermatitis: For adults and children 6 months and older.
• Moderate-to-severe eosinophilic asthma: For adults and children 6 years and older.
• Chronic rhinosinusitis with nasal polyps: For adults 18 years and older.
• Prurigo nodularis: For adults 18 years and older.
• Eosinophilic esophagitis (EoE): For adults and children 1 year and older.

Dupixent works by targeting and inhibiting specific pathways involved in the inflammatory process.

How Much Does Dupixent Cost Without Insurance?

The cost of Dupixent can vary depending on several factors, such as the pharmacy you use and your location. On average, the retail price for a month’s supply (two 2-milliliter prefilled syringes) is approximately $5,149.24. Prices can vary significantly between different pharmacies even within the same city.

Does Medicare Cover Dupixent?

Medicare Part D covers Dupixent if it is deemed medically necessary and is included in your plan’s formulary (the list of covered drugs). Each Medicare Part D plan has its own formulary, so coverage can vary between plans.

Sources:

• Medicare.gov – Drug Coverage (Part D)
• UnitedHealthcare – Does Medicare Cover a Chiropractor?

Prior Authorization and Step Therapy

Even if Dupixent is covered by your Medicare Part D plan, your provider may need to obtain prior authorization or demonstrate that other treatments were tried first (step therapy). This ensures that the medication is considered medically necessary for your specific condition.

Medicare Part B and Dupixent

Medicare Part B generally does not cover prescription drugs that patients can self-administer, like Dupixent. Part B focuses on drugs administered by a healthcare provider, such as intravenous medications given in a doctor’s office.

Cost of Dupixent with Medicare

The cost of Dupixent under Medicare Part D can vary depending on the plan and the phase of coverage:

• Initial Coverage Phase: You pay a co-pay, and the insurance covers the rest.
• Coverage Gap (Donut Hole): You pay a larger share of the drug cost until you reach the out-of-pocket spending threshold.
• Catastrophic Coverage Phase: Once you reach the out-of-pocket threshold, you pay significantly less for your drugs.

Sources:

• Medicare.gov – Costs for Medicare Drug Coverage
• GoodRx – Does Medicare Cover Chiropractic Care?

How to Save on Dupixent

If you cannot afford Dupixent, consider these options:

• Medicare Extra Help Program: A federal program that helps lower prescription drug costs for low-income individuals.
• Manufacturer Assistance Programs: Dupixent offers programs like the Dupixent MyWay Copay Card and the Dupixent MyWay Patient Assistance Program.

Other Common Medicare Coverage Questions

Does Medicare Cover Acupuncture? Medicare covers acupuncture for chronic low back pain only, limited to 12 visits in 90 days, with additional sessions if improvement is shown.

Does Medicare Cover Dental Care? Original Medicare does not cover most dental care, including cleanings, fillings, or dentures. Some Medicare Advantage plans may offer dental benefits.

Does Medicare Cover Vision Care? Medicare covers some preventive and diagnostic eye exams but not routine exams for glasses or contact lenses.

Does Medicare Cover Hearing Aids? Original Medicare does not cover hearing aids. Some Medicare Advantage plans offer hearing benefits.

Sources:

• Medicare.gov – Acupuncture
• Medicare.gov – Dental Services
• Medicare.gov – Vision Care
• Medicare.gov – Hearing Aids

Conclusion

Understanding Medicare coverage for Dupixent and other medical needs is crucial for managing your health and finances effectively. If you need assistance navigating your Medicare options or understanding coverage details, give us a call at 833-739-1122. Our experts are available 6am-4pm PST every weekday to help you find the best plan for your needs.

We simplify your health insurance search by comparing top plans to find the best, affordable coverage suited just for you. Picking the wrong health insurance policy can cost you, and the best options are usually not advertised. With millions enrolled in Medicare and ACA, personalized coverage is crucial not just to your wallet but to your health. Let us navigate the complex options to find the best plan for you.