The High Cost of Dupixent Without Insurance
Dupixent (dupilumab) is an FDA-approved biologic medication for specific types of chronic obstructive pulmonary disease (COPD). Because it is a specialty biologic drug, its retail price is very high compared to generic medications. Without insurance or discounts, the average retail price for a monthly supply of Dupixent (two prefilled pens) can range from about $3,344 to over $5,377, depending on the pharmacy and dosage. Annually, this could amount to tens of thousands of dollars, making treatment unaffordable for most individuals without financial assistance.
Costs with Commercial Insurance
Most commercial health insurance plans, including those from federal or state exchanges, offer some level of coverage for Dupixent. However, plans often require prior authorization or step therapy, meaning you must first try other, typically less expensive, treatments.
Even with coverage, the out-of-pocket expense can still be significant, based on your plan's deductible, copay, and coinsurance. The drug is typically placed in a high-cost specialty drug tier (Tier 5). Fortunately, the manufacturer provides a robust support program.
The Dupixent MyWay® Copay Card
For eligible patients with commercial insurance, the Dupixent MyWay Copay Card can significantly reduce out-of-pocket costs. This program allows many patients to pay as little as a $0 copay per fill.
Eligibility for the Copay Card includes:
- Having commercial health insurance (including plans from insurance exchanges).
- Being a resident of the 50 United States, Puerto Rico, or other U.S. territories.
- Having a prescription for an FDA-approved use, such as COPD.
The program has a maximum annual benefit of up to $13,000, and approval is not guaranteed.
Navigating Costs with Government-Funded Programs
Medicare
For patients on Medicare, Dupixent is typically covered by Medicare Part D prescription drug plans. While many Medicare Part D plans cover the medication, it is often in the highest tier, which means higher costs.
- Annual Cost Variation: Out-of-pocket expenses for Medicare Part D patients can fluctuate throughout the year depending on which coverage phase they are in (e.g., deductible, initial coverage, coverage gap).
- Typical Monthly Cost: Around 79% of Medicare Part D beneficiaries pay $100 or less per month for Dupixent. However, some patients will face higher costs.
- Extra Help Program: The Social Security Administration's Extra Help (Low-Income Subsidy) program can substantially lower monthly costs for those with limited income.
Medicaid
Medicaid coverage for Dupixent is dependent on the specific state's program, drug formulary, and eligibility criteria. For those who qualify, copayments for Dupixent are generally very low, ranging from $4 to $9 per month.
Additional Savings and Assistance
For uninsured patients or those facing gaps in coverage, several programs and resources can help offset the cost of Dupixent.
Dupixent MyWay® Patient Assistance Program
This program is specifically designed to help eligible uninsured or functionally uninsured patients receive Dupixent at no cost. Eligibility is based on household income and other specific criteria.
Prescription Discount Cards
Services like GoodRx and SingleCare offer coupons that can lower the retail price for uninsured patients. For instance, a SingleCare coupon might reduce the monthly cost into the $3,000–$4,000 range, though prices vary by pharmacy. These cards cannot be used in conjunction with insurance.
Charitable Foundations
Non-profit organizations, such as The Assistance Fund and Patient Advocate Foundation, may provide financial assistance grants for patients with specific medical conditions, including those on Medicare or with inadequate insurance.
Comparison of Dupixent Cost Options
| Cost Factor | Uninsured / Full Retail Price | Commercial Insurance (with MyWay Card) | Medicare Part D | Medicaid (varies by state) |
|---|---|---|---|---|
| Monthly Cost | ~$3,344 - $5,377 | As low as $0, with maximum annual benefit | $0 - $100+ | $4 - $9 |
| Best Savings Source | Patient Assistance Programs (for eligible) or discount cards | Dupixent MyWay® Copay Card | Extra Help program (for eligible) | State program eligibility |
| Key Conditions | Requires meeting income criteria for PAP; discounts vary | Must have commercial insurance and meet FDA-approved indication | Depends on plan formulary, deductible, and coverage phase | Varies by state; requires prior authorization |
Steps to Manage Your Dupixent Cost
- Verify FDA-Approved Use: Ensure your COPD diagnosis qualifies for Dupixent treatment. It is approved for specific types of COPD involving eosinophilic inflammation.
- Investigate Insurance Coverage: Contact your insurance provider directly. Ask about specific coverage, potential copays, coinsurance, and whether prior authorization or step therapy is required.
- Enroll in Dupixent MyWay®: If you have commercial insurance, enroll in the manufacturer's copay program online or by phone to see if you qualify for low or no copay.
- Assess Patient Assistance Programs: If you are uninsured or have limited coverage, explore the Dupixent MyWay Patient Assistance Program to see if you meet the income requirements for free medication.
- Consider Third-Party Discounts: If you are uninsured and don't qualify for PAP, check discount services like GoodRx or SingleCare and compare pharmacy prices.
- Seek Independent Guidance: Foundations like the Patient Advocate Foundation can offer resources and aid in navigating the complexities of medical financing.
- Use the Cost Tool: The Dupixent website features a Cost and Coverage Tool to help you understand your options based on your specific insurance situation.
Conclusion
The question of how much does Dupixent cost for COPD has no single answer, as the final price depends heavily on a patient's insurance status and financial resources. While the list price is substantial, most patients can significantly lower their out-of-pocket costs through a combination of insurance coverage and manufacturer or third-party assistance programs. By proactively researching available programs and working with healthcare providers, patients can manage the high costs and access this important medication.
