Understanding the List Price and Cycle Costs
Zepzelca (lurbinectedin) is a high-cost, specialty medication used to treat metastatic small cell lung cancer (SCLC) that has progressed after platinum-based chemotherapy. The starting point for determining its cost is the manufacturer's list price. As of late 2025, the manufacturer's list price for a single 4 mg vial of Zepzelca is approximately $8,110, though pharmacy price guides may show slight variations.
It is crucial to understand that the list price for one vial is not the total cost of a full treatment cycle. The dosage for Zepzelca is determined by a healthcare professional, administered via intravenous (IV) infusion on a specific schedule. A patient's required amount determines how many vials are needed per cycle. For instance, if the prescribed amount necessitates two vials, the drug cost alone for that cycle would be over $16,000, not including infusion and other associated medical fees.
Factors that influence the final cost of Zepzelca include:
- Insurance Coverage: What your plan covers, your deductible, copayments, and coinsurance. A high deductible plan could mean significant out-of-pocket costs at the start of treatment.
- Treatment Duration: The number of cycles a patient receives. In a clinical trial, the mean number of treatment cycles was 5.9, meaning the total cost can accumulate over several months.
- Infusion Site: Where the treatment is administered (e.g., hospital, outpatient infusion center). These settings have their own facility and administration fees, which can vary significantly.
- Associated Care: Costs for other required medications, supportive care, follow-up appointments, and management of any side effects. A separate analysis in Canada estimated that total monthly treatment costs, including administration and other associated care, could be over $19,000 CAD, further illustrating the complexity of total expenses.
Costs with and without insurance
Without robust insurance, the full cost of Zepzelca is prohibitively expensive for most patients. The expense includes the drug itself, pharmacy fees, and potentially thousands of dollars in facility fees for each infusion. This financial burden is why manufacturer patient assistance programs (PAPs) are so critical for uninsured or underinsured patients.
For commercially insured patients, out-of-pocket costs can still be substantial, especially with high deductibles or coinsurance percentages. Some commercially insured patients may be eligible for a savings card from the manufacturer to help reduce these costs significantly. However, patients with government-funded insurance like Medicare, Medicaid, or VA programs are typically not eligible for these savings cards.
Zepzelca Cost Comparison for One Infusion Cycle
| Factor | Uninsured/Underinsured | Commercially Insured (without savings card) | Commercially Insured (with savings card) | Medicare/Medicaid |
|---|---|---|---|---|
| Drug Cost (example: 2 vials) | ~$16,133 | After deductible/coinsurance | As low as $10 (subject to annual max) | Based on Part B coverage rules |
| Infusion Fees | Potentially several thousands | Coinsurance applies | Coinsurance applies | Varies by plan |
| Total Cost | Very high, full burden | Significant, depends on plan | Greatly reduced | Varies, depends on plan and supplement |
How JazzCares can help reduce Zepzelca costs
To mitigate the financial impact of Zepzelca, manufacturer Jazz Pharmaceuticals offers the JazzCares patient support program. This program provides multiple pathways to assistance for eligible patients:
- Patient Assistance Program: This program is available for eligible, uninsured or underinsured patients and can provide Zepzelca at no cost. Eligibility is based on financial and residency criteria.
- Savings Card: The JazzCares program offers a savings card for eligible, commercially insured patients. This card allows them to pay as little as $10 per prescription, subject to an annual maximum.
- Support Services: JazzCares also provides broader support, including assistance with insurance benefit investigations, prior authorizations, and referrals to other financial assistance options.
A comparison of Zepzelca with older SCLC treatments
Zepzelca is a targeted therapy, and its cost reflects the high research and development investment required for such innovations. To put its cost into perspective, it can be compared to older, more generalized chemotherapy regimens often used for SCLC, such as Cyclophosphamide plus Doxorubicin plus Vincristine (CAV).
A comparative review conducted for the Canadian Agency for Drugs and Technologies in Health (CADTH) found that the 21-day drug acquisition cost for lurbinectedin was significantly higher than older regimens. While the exact figures differ by country and are older, they illustrate the price difference. For example, the CADTH review calculated a 21-day cost of $12,940 CAD for lurbinectedin compared to much lower costs for other regimens like CAV or topotecan. This illustrates a common trend where novel, targeted agents are priced higher than conventional chemotherapy. However, these novel treatments often have different efficacy and side effect profiles, which must also be considered alongside cost.
Conclusion
The question of how much is Zepzelca in the US is complex, extending beyond its per-vial list price. Treatment costs are influenced by the patient's prescribed amount, the number of treatment cycles, insurance coverage, and associated medical fees. While the cost can be a major hurdle, resources like the JazzCares patient support program are essential for helping patients navigate the financial challenges. These programs can provide savings cards for those with commercial insurance or offer free medication for eligible uninsured and underinsured individuals, significantly reducing the financial burden for those who need Zepzelca.
For more information on the JazzCares program, visit the official website: https://www.jazzcares.com/patients/zepzelca.
