The Sticker Price vs. The Real Cost
The retail or 'sticker' price for a single dose of Neulasta (pegfilgrastim) is substantial, often ranging from approximately $6,000 to over $8,000, depending on the pharmacy. This is the price paid by those without any insurance or financial aid and serves as the baseline for all subsequent costs. However, this figure is rarely what patients end up paying. The final out-of-pocket cost is influenced by multiple factors, with health insurance being the most significant.
Insurance Coverage and Patient Costs
For most patients, the cost of a Neulasta shot is largely absorbed by their health insurance plan. The specific amount you will pay depends on the type of insurance you have (commercial, Medicare, Medicaid), your plan's formulary, and your deductible, coinsurance, or copay requirements. For many commercially insured patients, manufacturer-sponsored programs can significantly reduce or eliminate out-of-pocket costs.
- Commercially Insured Patients: With support programs like Amgen SupportPlus, many patients with private insurance may pay as little as $0 out-of-pocket for each dose. There are typically no income requirements for these programs.
- Medicare Patients: Neulasta is covered by some Medicare Part D and Medicare Advantage plans. The average copay can vary, and patients are subject to deductibles and coinsurance. Prior authorization is often required before Medicare will cover the cost.
- Medicaid and Uninsured Patients: Uninsured individuals will be responsible for the full retail price unless they qualify for a patient assistance program based on income. Amgen offers programs like the Safety Net Foundation to provide medication at no cost to qualifying patients.
The Onpro Injector vs. Prefilled Syringe
Neulasta is available in two main formats: a standard prefilled syringe for manual injection and the Onpro on-body injector device. The choice of administration method can impact the overall cost, as it affects where the drug is administered and associated fees.
- Prefilled Syringe: This is the traditional method, typically administered by a healthcare professional in a doctor's office or clinic. The cost includes the drug price, plus fees for the healthcare visit and administration, which can be substantial.
- Onpro On-Body Injector: This device is applied by a healthcare provider, often on the day of chemotherapy. It then automatically delivers the medication approximately 27 hours later, allowing the patient to receive the dose at home. While the device itself is included in the cost, using the Onpro may reduce total expenses by avoiding a separate clinic visit for the injection.
Biosimilars: An Affordable Path
Neulasta is a biologic medication, and several FDA-approved biosimilars are available on the market. A biosimilar is a highly similar version of a biologic drug with no meaningful differences in safety or effectiveness. These alternatives can significantly lower the financial burden for patients and the healthcare system.
Comparing Neulasta and Pegfilgrastim Biosimilars
| Drug Name | Type | Approximate Retail Price (without assistance) | Amgen/Manufacturer Program | Potential Patient Cost with Program | Availability |
|---|---|---|---|---|---|
| Neulasta | Reference Biologic | $6,000 - $8,000 per dose | Amgen SupportPlus ($0 copay for eligible patients) | Often as low as $0-$5 for eligible commercially insured patients | Prefilled syringe or Onpro device |
| Fulphila | Pegfilgrastim Biosimilar | ~$2,700 per dose | Biocon Biologics Patient Support Program | Depends on insurance plan; lower base cost | Prefilled syringe |
| Udenyca | Pegfilgrastim Biosimilar | Less than Neulasta | Coherus Complete | Depends on insurance plan; lower base cost | Prefilled syringe or On-body Injector |
| Ziextenzo | Pegfilgrastim Biosimilar | Less than Neulasta | Sandoz Patient Support Programs | Depends on insurance plan; lower base cost | Prefilled syringe |
Note: Prices and program details are subject to change. Always verify with your pharmacy, insurance, and the manufacturer.
Financial Assistance and Support Programs
Beyond insurance, numerous programs can help reduce or cover the cost of Neulasta and its biosimilars. These are crucial for patients facing high deductibles or without sufficient coverage.
- Amgen Assist 360™: Amgen's comprehensive support program can help with benefit verification, prior authorization assistance, and referrals to financial support.
- Independent Nonprofit Organizations: Organizations like the Patient Access Network (PAN) Foundation and NeedyMeds offer resources for low-income patients.
- Discount Cards: Services like GoodRx and SingleCare offer coupons that can significantly reduce the retail price of medications like biosimilars.
Conclusion
The question of how much does a Neulasta shot cost? does not have a single, simple answer. While the list price is high, the final expense for patients is largely dependent on their insurance plan and eligibility for various assistance programs. By exploring insurance benefits, considering biosimilar alternatives, and utilizing manufacturer or non-profit financial aid programs, patients can effectively manage the costs associated with this vital medication during chemotherapy. Always consult your healthcare provider and insurance company to determine the best treatment and most affordable options for your specific situation.
