Tagrisso (osimertinib) is a targeted therapy used to treat certain types of non-small cell lung cancer (NSCLC) with specific epidermal growth factor receptor (EGFR) mutations. While its therapeutic benefits are significant, the financial burden can be a major concern for patients and families. The list price is rarely what patients ultimately pay, as the final cost is heavily influenced by factors such as insurance coverage, financial assistance programs, and discounts.
The High Cost of Tagrisso Without Insurance
For individuals without health insurance or those whose insurance does not cover specialty drugs, the cash price for Tagrisso is exceptionally high. Data from various sources show the list price for a one-month supply of the 40mg or 80mg tablet can range from approximately $15,000 to over $30,000 in the United States. For perspective, a clinical review published by NCBI noted the annual cost of osimertinib could exceed $100,000 based on Canadian pricing, reflecting the high baseline expense of this medication. This staggering figure underscores why financial aid and discount programs are critical for most patients to afford treatment.
Insurance Coverage and Out-of-Pocket Expenses
How much a patient pays for Tagrisso largely depends on their insurance plan. Coverage and out-of-pocket costs differ across commercial, Medicare, and Medicaid plans.
Commercial Insurance
Most commercial insurance plans, including those offered by employers, cover Tagrisso. However, it is typically placed on a high-cost 'specialty tier' (Tier 5), meaning patients may face a high co-payment or coinsurance percentage until their annual deductible is met. The manufacturer, AstraZeneca, offers a Tagrisso Co-pay Savings Program for commercially insured patients. Eligible patients can pay as little as $0 per month, with the program covering up to a certain annual limit on out-of-pocket costs.
Medicare and Medicaid
Coverage for Tagrisso under government plans is more complex.
- Medicare Part D: Tagrisso is covered by most Medicare Part D plans, but it falls into the specialty tier, potentially leading to high out-of-pocket costs. However, changes under the Inflation Reduction Act set a new out-of-pocket maximum of $2,000 per year for Medicare Part D beneficiaries starting in 2025, which can significantly reduce costs for many patients.
- Medicaid: Eligibility and coverage for Tagrisso vary by state. It's crucial for patients to check their specific state's Medicaid guidelines and formulary.
Manufacturer co-pay programs are not valid for patients whose prescriptions are paid for by federal or state programs, including Medicare and Medicaid.
Financial Assistance and Savings Programs
For those struggling with the cost, several resources can provide significant relief.
Manufacturer Patient Assistance Programs
- AstraZeneca Access 360: This program offers personal support to help patients navigate their insurance coverage.
- AZ&Me Prescription Savings Program: This is a patient assistance program specifically for eligible uninsured or underinsured patients, providing AstraZeneca medications at no cost.
Independent Non-profit Foundations
Several non-profit organizations offer financial assistance for cancer medications, including Tagrisso. Eligibility is typically based on income and diagnosis.
- Patient Access Network (PAN) Foundation: Offers co-pay assistance for Medicare patients and others who meet eligibility criteria.
- HealthWell Foundation: Provides financial assistance for eligible individuals with cancer, covering a portion of prescription co-payments and other costs.
- The Assistance Fund: Offers co-pay assistance for patients with various health conditions, including lung cancer.
International Online Pharmacies
Patients can sometimes find Tagrisso at lower prices through CIPA-certified international online pharmacies. For example, PharmacyChecker lists international online pharmacies with significantly lower prices per tablet than US retail pharmacies.
Comparison of Tagrisso Costs (US)
| Cost Scenario | Estimated Monthly Cost | Relevant Factor | Notes |
|---|---|---|---|
| Uninsured / Cash Price | $15,000 - $32,000+ | High Specialty Drug Price | Highly variable; this is the list price |
| Commercial Insurance | Varies by deductible/coinsurance | Manufacturer co-pay card | Can be as low as $0 for eligible patients, up to an annual maximum benefit |
| Medicare Part D (2025) | Varies, but capped at $2,000 annually | New legal maximum | Out-of-pocket costs will not exceed $2,000 per year after deductible is met |
| Discount Cards | Variable (often thousands) | Discount card programs | WebMDRx and WellRx offer coupons reducing cash prices, but still potentially high |
| Patient Assistance Programs | Potentially $0 | Income and eligibility | Programs like AZ&Me provide medication at no cost to qualifying patients |
Practical Steps to Reduce Your Tagrisso Costs
Finding affordable access to Tagrisso requires proactive research and engagement. Here are some actionable steps:
- Review Your Insurance Plan: Understand your plan's formulary, deductible, co-payment, and coinsurance for specialty medications. Look up the specific details for your plan online or call a representative.
- Contact Your Specialty Pharmacy: Tagrisso is often dispensed by specialty pharmacies. Your pharmacy can provide detailed cost breakdowns and information on assistance programs.
- Enroll in the AstraZeneca Program: If you have commercial insurance, register for the Tagrisso Co-pay Savings Program through the AstraZeneca Access 360 website or by calling their support line.
- Apply to Independent Foundations: Visit the websites of foundations like PAN, HealthWell, and CancerCare to see if you meet their eligibility requirements for financial aid.
- Consider International Pharmacies: If you are uninsured or cannot afford your medication, research CIPA-certified online international pharmacies and compare their prices. A valid prescription is required.
- Explore Prescription Discount Cards: Use websites like WellRx or WebMDRx to find available coupons for Tagrisso at local pharmacies.
Conclusion
The cost of Tagrisso, while steep at its list price, is manageable for many patients thanks to a variety of financial support systems. For commercially insured patients, manufacturer co-pay programs can eliminate or drastically reduce monthly out-of-pocket costs. Those on Medicare can benefit from the 2025 out-of-pocket cap. For uninsured and underinsured individuals, a combination of manufacturer-sponsored patient assistance and independent non-profit foundation grants can make treatment accessible. By exploring all available options and seeking professional guidance, patients can secure the necessary medication without overwhelming financial hardship. For additional support, contact AstraZeneca Access 360 directly.
