Bimzelx List Price: The Starting Point
Before any discounts or insurance coverage are applied, the cost of Bimzelx is determined by its Wholesale Acquisition Cost (WAC), or list price. As of January 2025, the list price for one 1mL autoinjector or prefilled syringe is approximately $7,922.89. The typical dosage for plaque psoriasis is 320 mg initially, which requires two 160 mg injections (two syringes or autoinjectors). This means the initial dose carries a list price of over $15,800. The maintenance dose schedule varies, but the high list price underscores the importance of leveraging insurance coverage and other financial assistance options.
How Insurance Coverage Determines Your Final Cost
Your final out-of-pocket cost for Bimzelx is heavily dependent on the type of health insurance you carry. This cost can vary dramatically based on your specific plan's deductible, copayment, and formulary status.
Commercial Insurance
For patients with commercial insurance (e.g., through an employer or a private plan), the out-of-pocket cost can range from as little as $0 to a significant percentage of the list price, especially before meeting an annual deductible. However, the manufacturer, UCB, offers the BIMZELX Navigate® Savings Program, which can reduce the cost for eligible patients to as little as $5 per dose. Additionally, the BIMZELX Navigate® Bridge program assists commercially insured patients whose coverage is delayed or denied, allowing them to receive the medication for $15 per dose for up to two years. Many commercial plans require prior authorization for specialty medications like Bimzelx.
Medicare Coverage
For patients with Medicare Part D, out-of-pocket costs depend on their specific plan's formulary and where they fall in the annual benefit phases. For those who qualify for Medicare's 'Extra Help' program, prescription costs are significantly reduced, often falling between $4.50 and $11.20 per prescription. Patients not eligible for 'Extra Help' will experience fluctuating costs throughout the year. It is essential for Medicare patients to discuss their coverage with their plan provider.
Medicaid Coverage
Medicaid coverage for Bimzelx varies by state. For most Medicaid patients, monthly prescription copayments range from $4.95 to $9.85. Some states even waive copay requirements entirely. Eligibility for Medicaid depends on individual income and state guidelines. Information is available on the Medicaid website.
Uninsured and Underinsured Patient Assistance Programs
For individuals who are uninsured, whose insurance does not cover Bimzelx, or who cannot afford their portion of the cost, several programs are available:
- UCBCares® and Patient Assistance Program: UCB operates UCBCares®, which can connect uninsured patients to financial assistance. This program helps patients navigate their options and may assist with finding an independent organization that can help.
- Patient Access Network (PAN) Foundation: PAN provides financial assistance for prescription copayments, including for Bimzelx, to eligible Medicare and commercially insured patients who meet income criteria.
- HealthWell Foundation: This foundation also offers copayment assistance to help insured patients with the cost of their medication.
- Patient Advocate Foundation (PAF): The PAF Co-Pay Relief Program can help with co-pays, co-insurance, and deductibles for qualifying patients.
Comparing Bimzelx Cost Factors and Coverage
To illustrate the dramatic impact of insurance and assistance on the out-of-pocket cost, consider the following comparison of potential payment scenarios.
| Scenario | Insurance Type | Patient Cost | Notes |
|---|---|---|---|
| Full List Price | None (Uninsured) | ~$7,922 per 1mL syringe | Before any assistance; highly variable based on dosage. |
| With Savings Card | Commercial Insurance (approved) | As little as $5 per dose | Requires enrollment in BIMZELX Navigate® Savings Program. |
| With Bridge Program | Commercial Insurance (pending) | $15 per dose (up to 2 years) | Requires enrollment in BIMZELX Navigate® Bridge Program. |
| With 'Extra Help' | Medicare Part D | $4.50 - $11.20 per prescription | For eligible low-income patients. |
| Typical Copay | Medicaid | $4.95 - $9.85 per month | Varies by state; some states may have no copay. |
Tips for Managing Bimzelx Costs
Managing the high cost of a specialty medication like Bimzelx requires proactive steps. Here is a list of actions you can take:
- Start with your doctor's office: They can initiate the process for prior authorization and refer you to a Nurse Navigator through the BIMZELX Navigate™ program.
- Contact your insurance provider: Always call your insurance company to understand your specific plan's formulary, deductible status, and requirements for specialty medications.
- Enroll in the manufacturer's program: The BIMZELX Navigate™ program provides not only financial support but also nurse guidance and other resources.
- Explore external foundations: If you have Medicare or high commercial insurance copays, check eligibility for assistance programs from non-profits like PAN and HealthWell.
- Consider a mail-order pharmacy: Some insurance plans and pharmacies offer discounts or lower costs for a 90-day supply of medication filled through the mail.
Conclusion: Navigating the Complexities of Medication Costs
While the list price of Bimzelx is substantial, it is not the reality for the vast majority of patients. The complexity of medication costs, particularly for specialty drugs like Bimzelx, means the final price is determined by a combination of insurance coverage, patient assistance programs, and individual circumstances. By working closely with healthcare providers and taking advantage of available support programs, patients can significantly reduce their out-of-pocket costs and ensure access to their prescribed treatment.
For more information on the BIMZELX Navigate™ program, you can visit the official website: www.bimzelx.com.
