Tepezza, also known as teprotumumab-trbw, is a prescription medication used to treat Thyroid Eye Disease (TED). Administered intravenously in a series of eight infusions, it has proven effective in treating the condition, but its high cost is a major consideration for many patients. The final out-of-pocket cost is influenced by multiple factors, including insurance, dosage, and available financial support.
The High List Price and What It Means
The wholesale acquisition cost (WAC) of Tepezza, the price at which the manufacturer sells the drug to wholesalers, is the starting point for its high cost. Multiple reports from recent years have placed the WAC for a 500-mg vial in the range of approximately $14,900 to over $17,000. Some data lists an even higher cash price for a single vial. This represents the price before any negotiations, discounts, or insurance coverage apply, and is not what most insured patients will actually pay. For uninsured patients, the cost can be financially crippling, with some reporting bills near $150,000 for a full course of treatment.
Factors That Determine Your Final Cost
Several elements work together to determine a patient's final financial responsibility for Tepezza. These factors can create a vast difference in cost from one individual to another, even for those with similar diagnoses.
- Body weight: Tepezza is dosed based on body weight (mg per kg), meaning a heavier patient will require more medication and, therefore, more vials per infusion than a lighter patient. A standard eight-infusion course for an average-weight adult uses roughly one vial per treatment, but heavier patients may require double the drug quantity.
- Insurance coverage: The patient's specific health insurance plan is the single most important factor in determining the out-of-pocket cost. Coverage can vary between commercial plans, Medicare, Medicaid, and other government programs. Coverage is almost never 100%, and deductibles and coinsurance can still leave patients with significant expenses.
- Site of infusion: Where a patient receives their infusion can heavily impact the cost. Hospital-based infusion centers often have higher facility fees than outpatient or standalone clinics. In some cases, home infusion may even be an approved option, potentially reducing these costs.
- Deductible status: The timing of treatment can affect costs, especially with high-deductible plans. Starting therapy near the end of a calendar year could potentially require paying two separate deductibles if the eight-infusion course spans across the new year.
- Prior authorization: Insurance companies almost always require prior authorization for Tepezza before they will cover it. Skipping this step can result in the patient being responsible for the full cost of treatment.
Patient Assistance Programs Can Drastically Reduce Costs
Recognizing the financial burden of Tepezza, Amgen (the manufacturer) provides a robust patient support program called "Amgen By Your Side". This program offers significant financial assistance and is a crucial resource for many patients. Key components of this program include:
- Commercial Copay Program: For commercially insured patients, this program can reduce their out-of-pocket costs for both the medication and the infusion process to as little as $0, subject to an annual maximum.
- Resource Investigation: For patients with government insurance (e.g., Medicare, Medicaid) who are not eligible for the copay program, the team can help find support from independent foundations.
- Patient Access Liaisons (PALs): These are dedicated support partners who help patients navigate the complex insurance and logistical processes.
Comparison of Estimated Tepezza Treatment Costs
To illustrate the financial differences, the table below provides estimated cost scenarios for a standard eight-infusion course of Tepezza, based on data available from healthcare resources.
| Scenario | Estimated Drug Cost (before insurance) | Estimated Out-of-Pocket Cost (with assistance) | Notes |
|---|---|---|---|
| Uninsured/Cash Pay | ~$120,000 - $160,000+ | ~$120,000 - $160,000+ | Does not account for any assistance programs. Facility fees and other costs are additional. |
| Commercially Insured | ~$120,000 - $160,000+ | As low as $0, limited by annual program maximums | Requires enrollment in the Amgen By Your Side Copay Program. |
| Medicare Part B | ~$120,000 - $160,000+ | Variable, typically 20% coinsurance plus facility fees | Out-of-pocket costs can still be substantial, though Medigap plans may help cover some of the coinsurance. |
| Medicare & Foundation Grant | ~$120,000 - $160,000+ | Potentially significantly reduced, depending on grant | Patients with government insurance may seek income-based grants from foundations to help with costs. |
Conclusion: Sticker Shock vs. Real-World Costs
While the sticker price of a single vial of Tepezza is extremely high, ranging from $15,000 to over $17,000, it is not the final word on patient costs. The final out-of-pocket expense depends on a complex web of factors including insurance, dosing, and where the infusion is received. The most critical takeaway is the availability of robust patient assistance programs, such as Amgen By Your Side, which can dramatically reduce or even eliminate the financial burden for eligible patients. Anyone considering Tepezza treatment should work closely with their doctor and utilize the resources provided by the manufacturer to understand their individual financial responsibilities and options.
For more information on the manufacturer's patient support resources, visit the official website: TEPEZZA® (teprotumumab-trbw) Cost and Support.
