Understanding the High Cost of Verzenio
Verzenio (abemaciclib) is a CDK4/6 inhibitor prescribed for certain types of breast cancer. As a specialty medication, its retail price is high, and your out-of-pocket expenses can vary dramatically depending on your insurance coverage. For commercially insured individuals, it is often placed on a high-cost specialty tier (Tier 5), meaning even with insurance, copayments or coinsurance can be substantial. For Medicare Part D recipients, costs fluctuate based on the benefit phase (deductible, initial coverage, donut hole, catastrophic). Fortunately, numerous pathways exist to significantly lower or even eliminate these costs for eligible patients.
Manufacturer and Foundation Programs for Verzenio
Both the manufacturer, Eli Lilly, and independent nonprofit foundations offer robust assistance programs to help patients afford their medication. These programs have specific eligibility requirements, so it is important to investigate each one carefully.
The Eli Lilly Verzenio Savings Card
The Verzenio Savings Card is available for eligible patients with commercial health insurance. This program allows qualified patients to pay as little as $0 for a 28-day supply of Verzenio, though it is subject to a monthly and an annual cap. It is crucial to note that this card is not valid for patients enrolled in government-funded programs like Medicare, Medicaid, or TRICARE.
To enroll in the program, you can apply online through the Verzenio website or call the Lilly Oncology Support Center for assistance. Eligibility requires that you have been prescribed Verzenio for an FDA-approved use and reside in the U.S. or Puerto Rico. Your specialty pharmacy can also help determine your eligibility.
Lilly Cares Foundation Patient Assistance Program
For uninsured and underinsured patients who meet certain income guidelines, the Lilly Cares Foundation offers free medication. This program is designed for U.S. residents who do not have Medicaid or certain other government benefits. This is a lifeline for many who lack adequate coverage or whose insurance plan does not cover Verzenio. You can find eligibility information and application forms on the Lilly Cares website.
Independent Foundation Assistance
Several independent charitable foundations provide financial assistance for patients facing high out-of-pocket costs for medications like Verzenio. These programs are often available for patients with commercial or government insurance (including Medicare) to help cover copays, deductibles, and coinsurance.
- Patient Access Network (PAN) Foundation: Offers assistance for specific diagnoses and income levels, often helping with copayments.
- HealthWell Foundation: Provides financial aid to cover out-of-pocket costs for patients with various health conditions, including breast cancer.
- Patient Advocate Foundation (PAF) Co-Pay Relief Program: Offers direct financial assistance to help patients pay for the cost of their medication.
Insurance and Pharmacy Strategies
Even with insurance, costs can be managed more effectively by understanding your plan and shopping around.
Navigating Medicare Part D Coverage
For Medicare beneficiaries, Verzenio typically falls under a specialty tier with high out-of-pocket costs, particularly in the deductible and coverage gap (donut hole) phases. There are, however, options for eligible seniors to reduce these expenses:
- Extra Help: The Low Income Subsidy (LIS) program, known as Extra Help, assists Medicare beneficiaries with their Part D costs. Eligibility depends on income and resources. This program can significantly reduce drug costs.
- Changing Plans: Medicare drug plans and their formularies can change annually. Regularly reviewing and comparing plans can ensure you are on the most cost-effective option.
Comparing Pharmacies and Using Mail-Order
Verzenio is typically dispensed by a specialty pharmacy. Costs can vary between different specialty and mail-order pharmacies. Asking your doctor to use a specialty pharmacy that offers the lowest out-of-pocket cost is a smart move. Some insurance plans may also offer better rates or allow for a cost-saving 90-day supply through mail-order services.
Leveraging Prescription Discount Cards and Coupons
Websites and cards like WellRx or NowPatient allow you to compare prices and find coupons for your prescriptions. While these discounts may be more limited for specialty drugs, they can still help reduce costs at local retail pharmacies.
Exploring Alternatives: Generic and International Options
As of now, there is no generic version of Verzenio (abemaciclib) available in the U.S.. This means cost-saving options must focus on navigating existing brand-name programs rather than a cheaper generic alternative.
In some cases, patients may consider international online pharmacies. CIPA-certified (Canadian International Pharmacy Association) online pharmacies are regulated and may offer significant savings compared to U.S. retail prices. However, this is not without risk, and patients must ensure they use only reputable, certified pharmacies and have a valid prescription.
Comparison Table of Verzenio Cost-Saving Methods
| Method | Best For | Eligibility | How It Works | Key Considerations |
|---|---|---|---|---|
| Eli Lilly Savings Card | Commercially insured patients | Commercial insurance, not government plans | Reduces monthly copay to as little as $0 | Not for Medicare/Medicaid; subject to annual caps. |
| Lilly Cares Foundation | Uninsured or underinsured patients | Meet income/residency criteria | Provides free medication | Requires valid prescription and documentation. |
| Independent Foundations (PAN, HealthWell) | Insured patients with high copays/deductibles | Meet income and disease-specific criteria | Offers grants for out-of-pocket costs | Funding availability can vary; requires application. |
| Medicare Extra Help (LIS) | Medicare patients with limited income | Meet specific income and resource limits | Reduces Part D costs, including Verzenio | Federal program requiring specific eligibility. |
| Pharmacy Comparison / Mail-Order | All patients | Varies by pharmacy/insurance | Compare prices, use mail-order savings | Requires checking with your plan and pharmacy. |
| International Pharmacies | Patients paying full retail cost | Requires valid prescription | Significantly lower cost via certified online pharmacies | Check for CIPA certification; legal/safety concerns. |
Conclusion: Crafting Your Financial Strategy
Managing the high cost of Verzenio requires a proactive and multi-faceted approach. There is no single solution, and what works best depends on your specific insurance situation. Start by discussing financial concerns with your healthcare team, who can provide resources and refer you to appropriate programs. Commercially insured patients should leverage the Eli Lilly Savings Card, while uninsured or underinsured patients should explore the Lilly Cares Foundation. For those on Medicare, investigating the 'Extra Help' program is a vital step. Finally, comparing pharmacy options and exploring independent charitable foundations can provide additional layers of support. By exploring all these avenues, patients can significantly reduce the financial burden of their Verzenio treatment.
Verzenio Dosage Adjustment
For patients on Verzenio who need a dose reduction, Lilly offers the MyRightDose program. This program provides the appropriate new dose at no extra cost, ensuring patients can continue treatment without interruption. Eligible patients need to return their unused pills and follow the program's instructions. This benefit helps prevent costs associated with discarded or unused medication when a dose change is necessary.
Additional Considerations
- Prior Authorization: Many insurance plans, including Medicare, require prior authorization before they will cover Verzenio. This means your doctor must provide documentation to the insurance company justifying the prescription. Your healthcare team can assist with this process.
- Lilly Oncology Support Center: This center acts as a central resource for patients prescribed Lilly products, offering personalized support with benefits investigations and financial assistance. Their dedicated phone number is a direct line to assistance for Verzenio patients.
