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Understanding How Much Does the Taltz Injection Cost?

4 min read

With a list price exceeding $7,200 per individual injection pen, the question of how much does the Taltz injection cost is a significant concern for patients. The final out-of-pocket expense, however, can vary dramatically based on your specific insurance coverage, eligibility for savings programs, and other factors.

Quick Summary

Taltz injection costs vary significantly, with list prices reaching thousands of dollars per month. Patient out-of-pocket costs are substantially lower with insurance, and manufacturer savings cards and patient assistance programs can reduce expenses to as little as $5.

Key Points

  • High List Price: The manufacturer's list price for one Taltz injection pen is over $7,200, though this is rarely what patients pay.

  • Variable Cost with Insurance: What you pay for Taltz depends heavily on your insurance type, including commercial, Medicare Part D, and Medicaid.

  • Significant Savings for Commercially Insured: Eligible commercially insured patients can use a manufacturer's savings card to lower their monthly cost to as little as $5.

  • Assistance for All Insurance Types: Costs for Medicare and Medicaid patients are managed through plan specifics, with additional programs like 'Extra Help' for eligible low-income individuals.

  • Manufacturer Patient Assistance Programs: For uninsured or underinsured patients, programs like Lilly Cares can provide Taltz at no cost if eligibility requirements are met.

  • Cost Comparison is Crucial: Taltz's annual cost is competitive with other biologics, but comparing options with your doctor and insurance provider is recommended.

  • Use Available Resources: Working with your doctor and specialty pharmacy to understand coverage and savings options is key to managing medication costs.

In This Article

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.

Frequently Asked Questions

For eligible commercially insured patients using a manufacturer savings card, the cost can be as low as $5 per 28-day supply. However, depending on the plan, co-payments and deductibles can vary, with an average of around $507 per month for some commercially insured patients before savings.

Without insurance, the cash price for a single Taltz injection pen is close to the list price of over $7,200. Discount cards might lower the price slightly, but the cost remains very high.

Eligible commercially insured patients can enroll in the Taltz Savings Card program online through the manufacturer's website or by calling the provided helpline. It is important to review the terms and conditions, as it is not available for government-insured individuals.

Yes. Eli Lilly, the manufacturer, offers the Lilly Cares program. This patient assistance program provides Taltz at no cost to eligible uninsured or underinsured individuals who meet specific financial and medical criteria.

Medicare Part D patients experience costs that depend on their coverage phase (deductible, initial coverage, catastrophic). Some may also be eligible for the 'Extra Help' program, which can drastically lower monthly costs.

Taltz is a specialty medication, and coverage varies by plan. Your specialty pharmacy will work with your healthcare team and insurance provider to confirm coverage and help with any required prior authorization processes.

If you have an annual deductible, you will generally pay higher prices for your medication, including Taltz, until you meet that deductible amount. After that, your costs will typically be limited to a copayment or coinsurance as determined by your plan.

References

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Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice.