Tepezza, or teprotumumab, is the first FDA-approved medication specifically for treating Thyroid Eye Disease (TED). Administered via a series of intravenous (IV) infusions, it represents a significant advance in treating this condition, but its high cost can be a major hurdle for patients. Understanding the factors that influence the price, from the drug's list price to personal out-of-pocket expenses, is critical for those considering treatment.
Understanding the High List Price of Tepezza
Tepezza carries a substantial list price, a common feature of specialty drugs for rare diseases that do not have direct competition. While the wholesale acquisition cost (WAC) for a single 500-mg vial of Tepezza has been reported at approximately $14,900 to over $17,000, the total cost for a full treatment course is far higher.
A standard course of Tepezza treatment involves eight infusions over a 24-week period. The dosage is weight-based, requiring more vials for heavier patients. As a result, the total before-insurance cost for a complete course can range from $120,000 to over $400,000, depending on the patient's specific dosing needs. This price does not include additional medical costs associated with the treatment process.
Factors Influencing Your Personal Tepezza Costs
While the sticker price is daunting, many patients do not pay the full amount out-of-pocket. The final cost to an individual is determined by several key factors:
- Insurance Coverage: The type of insurance a patient has (commercial, Medicare, Medicaid) and the specifics of their plan's coverage for specialty drugs are the primary determinants of cost. Tepezza often requires prior authorization from insurers.
- Patient Weight and Dosage: Since the medication is dosed based on body weight, a heavier patient will require more vials per infusion, directly increasing the total cost of the drug component of their treatment.
- Infusion Site: The location where the infusions are administered can significantly affect facility fees. Hospital-based infusion centers typically have higher costs than standalone clinics or, if approved, home infusion services.
- Associated Medical Costs: Beyond the drug itself, patients must also account for costs related to physician visits, monitoring labs (e.g., thyroid function, blood sugar), and potential imaging like MRIs or CTs required for insurance pre-authorization.
Financial Assistance and Cost Reduction Strategies
Navigating the high cost of Tepezza often requires proactive engagement with assistance programs and careful financial planning. The manufacturer, Amgen (formerly Horizon Therapeutics), offers a patient support program called Amgen By Your Side.
Amgen By Your Side Program
This program provides comprehensive support for patients, helping them navigate the insurance approval process, understand their benefits, and explore financial assistance options. For commercially insured patients who meet the eligibility criteria, the program may offer a $0 co-pay for both the medication and the IV infusion process.
- Eligibility: The co-pay program is generally available only to commercially insured individuals. Patients with government-funded insurance like Medicare or Medicaid are typically not eligible for the manufacturer's co-pay card.
- Support for Other Patients: For those with government insurance or who are uninsured, Amgen By Your Side can help identify independent charitable foundations that offer financial grants to cover drug and infusion costs.
Practical Strategies for Patients
Beyond manufacturer assistance, patients can take several steps to minimize their financial burden:
- Time therapy around deductible resets: Aligning the start of treatment with the beginning of a new insurance policy year can potentially prevent having to pay two separate deductibles.
- Explore home infusion: Some insurers may approve at-home administration, which can significantly reduce facility fees charged by hospitals or clinics.
- Negotiate single-case agreements: If a preferred infusion center is out-of-network, you can request your insurer negotiate a one-time, in-network rate.
- Seek foundation grants: For those with Medicare or no insurance, income-based programs from foundations like PAN Foundation can provide assistance.
Comparison of Tepezza and Other TED Treatment Costs
Before Tepezza's FDA approval, treatment for TED typically involved older, less effective medications or surgery. The cost disparity is significant.
| Treatment Option | Estimated Full Course Cost (Before Insurance) | Relative Efficacy for Proptosis | Notes |
|---|---|---|---|
| Tepezza (Teprotumumab) | $120,000 - >$400,000 | High; significant proptosis reduction | First FDA-approved drug for TED. Requires eight IV infusions over 24 weeks. |
| IV Corticosteroids (e.g., Methylprednisolone) | ~€70 - €172 in the US | Low to Moderate; less impact on proptosis | Standard prior to Tepezza. Limited efficacy and potential side effects. |
| Rituximab (off-label) | ~$18,549 (including infusion fees) | Emerging evidence shows potential benefit | Off-label use, less evidence specifically for TED treatment. |
| Orbital Decompression Surgery | ~$21,875 per procedure | Varies by complexity and patient | Surgical option for chronic TED, potentially multiple surgeries required. |
Conclusion
Tepezza is a highly effective, but exceptionally expensive, treatment for Thyroid Eye Disease. Its list price places it among the most costly medications on the market, but the out-of-pocket expense for patients varies dramatically based on their insurance coverage, dosage requirements, and infusion site. Fortunately, robust financial assistance programs like Amgen By Your Side and independent foundations exist to help eligible patients manage the financial burden. For prospective patients, it is vital to work closely with your healthcare team and a patient access liaison to understand the total cost, explore all available financial aid options, and develop a comprehensive plan before beginning treatment. Informed planning is the best strategy to navigate the complexities of Tepezza's cost while focusing on your health. For more detailed information on financial assistance, patients can visit the manufacturer's program website. Amgen By Your Side
