The High List Price vs. Your Out-of-Pocket Cost
The most important distinction to understand when asking how much does the Taltz injection cost is the difference between the 'list price' and your actual out-of-pocket expense. The list price is the drug's official price set by the manufacturer, Eli Lilly, and is not what most patients pay. According to Lilly, the list price for one 80mg Taltz pen is $7,261.51. This is the price used for insurance billing and serves as the baseline for negotiations and calculations, especially for uninsured individuals. Your out-of-pocket cost is the amount you personally pay after your insurance and any applicable discounts are applied.
How Taltz Costs Vary with Insurance Coverage
Insurance status is the biggest determinant of what you will actually pay for Taltz. Each type of plan has different rules and levels of coverage for specialty medications like Taltz.
For Commercially Insured Patients
For patients with private health insurance through an employer or individual policy, the costs can range widely, but many are able to access significant savings. A majority of commercially insured patients with Taltz coverage pay very little out-of-pocket, thanks to manufacturer-sponsored savings cards.
- Manufacturer Savings Card: Eligible, commercially insured patients can use the Taltz Savings Card to pay as little as $5 per 28-day supply. This program often has an annual savings cap and is subject to specific terms and conditions.
- Annual Deductible: If you have not met your annual deductible, you may face higher costs until that amount is reached. Once the deductible is met, your out-of-pocket costs, such as copayments or coinsurance, will likely decrease.
For Medicare Part D Patients
Medicare patients' costs can fluctuate throughout the year depending on their coverage phase.
- Deductible Phase: Patients pay the full cost of the medication until their deductible is met.
- Initial Coverage Phase: After meeting the deductible, patients will pay a portion of the cost, such as a 25% coinsurance, until they reach a certain out-of-pocket threshold.
- Catastrophic Phase: The cost structure changes again after a patient's out-of-pocket spending hits a specific limit for the year.
- Extra Help Program: Some Medicare patients with limited income may qualify for the Extra Help program, which can lower monthly costs significantly to as low as $4 to $9.
For Medicaid Patients
Patients covered by Medicaid generally have the lowest out-of-pocket costs. Monthly copays for medications like Taltz typically range from $4 to $9, though some states may have even lower costs or no copay at all.
The Cost Without Insurance
For those without insurance or whose insurance does not cover Taltz, the cost is the most burdensome. These individuals can expect to pay close to the full list price, plus any pharmacy fees. Discount card prices for a single autoinjector can still be very high, often around $6,950. Without financial assistance, the monthly and annual costs can be prohibitive.
How to Save on Your Taltz Injection
There are several ways to reduce the cost of your Taltz prescription:
- Eli Lilly's Savings Card: As mentioned, this is a primary method for commercially insured patients to reduce their monthly co-pay to as low as $5.
- Patient Assistance Programs (PAPs): Eli Lilly offers a Patient Assistance Program called Lilly Cares for eligible, uninsured, or underinsured patients to receive Taltz at no charge. Other organizations like the PAN Foundation also offer financial assistance.
- Prescription Discount Cards: While not as effective for specialty biologics as for generic drugs, some services like GoodRx offer savings, although the cost without manufacturer programs remains high.
- Doctor's Office Support: Your doctor's office and specialty pharmacy can be a valuable resource for navigating the cost of Taltz. They can help you with prior authorizations and applications for patient assistance programs.
Taltz vs. Other Biologics: A Cost Comparison
Comparing the cost of Taltz to other biologics is complex due to varying dosages and pricing models. The following table provides a general comparison based on published cost data for psoriatic arthritis treatment.
Drug (Active Ingredient) | Average Annual Cost (1st Year) | Indicated Condition(s) |
---|---|---|
Taltz (Ixekizumab) | ~$21,600 to $26,300 | Psoriatic Arthritis, Plaque Psoriasis, Ankylosing Spondylitis |
Humira (Adalimumab) | ~$20,100 | Psoriatic Arthritis, Plaque Psoriasis, Rheumatoid Arthritis |
Cosentyx (Secukinumab) | ~$13,200 | Psoriatic Arthritis, Plaque Psoriasis, Ankylosing Spondylitis |
Enbrel (Etanercept) | ~$21,200 | Psoriatic Arthritis, Plaque Psoriasis, Rheumatoid Arthritis |
Stelara (Ustekinumab) | ~$23,000 | Psoriatic Arthritis, Plaque Psoriasis, Crohn's Disease |
It is crucial to note that these are average costs, and your specific out-of-pocket expense depends on your insurance coverage and assistance programs. Costs can also fluctuate year over year.
Conclusion
While the sticker price for a Taltz injection is thousands of dollars, what you pay is highly dependent on your insurance status and ability to leverage assistance programs. The manufacturer, Eli Lilly, provides substantial support for commercially insured patients through its savings card, dramatically lowering the out-of-pocket cost. Medicare and Medicaid recipients also benefit from capped or subsidized pricing. For those without insurance, the cost is a significant barrier, but manufacturer patient assistance programs like Lilly Cares can help. Understanding your specific coverage and taking advantage of available savings resources is essential to manage the cost of Taltz effectively. For the most up-to-date information on savings programs, it is best to visit the manufacturer's official support website.