The introduction of new, effective treatments for conditions like moderately to severely active ulcerative colitis (UC) often comes with a hefty price tag. Velsipity (etrasimod), an oral, once-daily medication from Pfizer, is no exception. Patients navigating this new therapy must consider the financial implications alongside the clinical benefits. The final cost for an individual depends on their insurance status and proactive utilization of available savings programs.
The High Retail Price of Velsipity
Before any discounts or insurance coverage are applied, the cash or retail price for Velsipity is substantial. A 30-day supply of Velsipity 2mg tablets can range from approximately $6,200 to over $7,700, according to drug pricing websites. The annual cost could be upward of $75,000 based on the wholesale acquisition cost from 2023. This high cost is typical for new specialty medications, which are often priced to reflect the research, development, and clinical trial investments made by the manufacturer. For individuals without insurance, or those on plans that do not cover the drug, this retail price is the starting point for negotiation and seeking assistance.
The Impact of Insurance Coverage
For most Americans, the retail price is not the amount they will pay out-of-pocket. Prescription drug insurance coverage through a commercial plan, Medicare, or Medicaid will reduce the financial burden. However, even with insurance, the final cost is not straightforward and depends on several factors:
- Prior Authorization: Most insurance plans will require prior authorization for Velsipity. This means a healthcare provider must submit documentation to the insurer to prove the drug is medically necessary and that other treatments were ineffective. Without prior authorization, the patient could be responsible for the full retail cost.
- Tiered Coverage: Specialty medications like Velsipity are typically placed on a high-cost specialty drug tier, which may come with a high copay or coinsurance percentage, even after a deductible is met.
- Deductibles and Out-of-Pocket Maximums: Patients will need to pay the full cost until their annual deductible is met. This can result in high initial costs at the beginning of a new plan year.
Manufacturer Savings Programs
Pfizer, the manufacturer of Velsipity, offers extensive support to help patients afford their medication. These programs are structured to address the needs of both commercially insured and uninsured patients.
Velsipity Copay Savings Program
This program is designed for eligible commercially insured patients to help reduce their monthly copayment. Key features include:
- Low to No Copay: Eligible patients can pay as little as $0 out-of-pocket for each qualifying prescription.
- Annual Maximum Benefit: The program provides a maximum annual benefit, with figures reported ranging from $4,000 to $16,000 per calendar year, though this can vary.
- Reimbursement: Patients who pay upfront can submit receipts for reimbursement.
- Baseline Assessments: The program also covers up to $2,500 in qualified out-of-pocket expenses for required prescreening tests.
Pfizer Patient Assistance Program
For qualifying low-income patients who are uninsured or underinsured, the Pfizer Patient Assistance Program offers Velsipity for free. This is a critical safety net for those who would otherwise have no access due to cost. Eligibility is based on income guidelines relative to the Federal Poverty Level.
How to Reduce Your Velsipity Costs
To navigate the costs associated with Velsipity, patients should follow a methodical approach:
- Talk to Your Doctor: Discuss the financial implications and potential costs before starting treatment. Your provider's office is often the first stop for enrollment in patient support programs.
- Understand Your Insurance: Call your insurance provider to understand their specific coverage, prior authorization requirements, and your expected copay or coinsurance for Velsipity.
- Enroll in VelsipityForMe: This is Pfizer's patient support portal, accessible via a link provided by your physician. It streamlines enrollment in the Copay Savings Program and connects you with insurance and reimbursement support.
- Explore Discount Cards: Use pharmacy coupon websites, like GoodRx or Drugs.com, which can provide discounts for cash-paying customers or be used in conjunction with certain insurance plans.
- Utilize Mail-Order Pharmacies: For some patients, using a mail-order pharmacy approved by their insurer could potentially lower costs and offer convenience.
- Seek Other Assistance: Websites like NeedyMeds can provide information on other drug assistance programs.
Comparison of Velsipity and Zeposia Costs
Comparing the costs of Velsipity to other advanced ulcerative colitis therapies can help provide context for the overall price. Bristol Myers Squibb's Zeposia (ozanimod) is another oral S1P receptor modulator for UC.
| Cost Factor | Velsipity (Etrasimod) | Zeposia (Ozanimod) | Commentary |
|---|---|---|---|
| Retail Price (30-day supply) | Approx. $6,200 - $7,700 | Approx. $8,386 | Both are high-cost specialty medications with comparable retail prices. |
| With Commercial Insurance | Depends on plan; can be as low as $0 with manufacturer copay card | Depends on plan; similar copay assistance programs are available from the manufacturer. | Copay assistance programs are crucial for both to reduce out-of-pocket costs. |
| With Patient Assistance | Free for eligible low-income, uninsured individuals via Pfizer PAP | Patient assistance programs also exist for uninsured/underinsured patients of Zeposia. | Both manufacturers have programs for those with low or no insurance coverage. |
| Wholesale Acquisition Cost (Annual Estimate) | ~$75,000 | Varies; similarly high annual cost. | The annual cost of advanced UC therapies is typically very high. |
More information on managing medication costs can be found on resources like the Medicine Assistance Tool.
Conclusion
While the sticker price for Velsipity is substantial, the final amount paid by patients in the US is highly dependent on their insurance plan and participation in manufacturer-sponsored programs. For many with commercial insurance, the out-of-pocket cost can be reduced to as low as $0 per month through the Copay Savings Program. For those who are uninsured or underinsured and meet specific criteria, the Pfizer Patient Assistance Program offers a vital pathway to receive the medication at no cost. By working closely with healthcare providers and exploring all available resources, patients can effectively manage the costs associated with this important treatment for ulcerative colitis.
