Understanding the High Retail Price of Tagrisso
Tagrisso (osimertinib) is a targeted therapy used to treat non-small cell lung cancer (NSCLC) with specific epidermal growth factor receptor (EGFR) mutations. As a brand-name, specialty medication, it commands a very high price point. The cost without any insurance or discounts is substantial, with U.S. retail pharmacies listing the price for a 30-day supply (30 tablets, 40mg each) at approximately $5,868 to $5,881. This translates to a per-tablet cost of nearly $200.
The high cost is a result of several factors inherent to the specialty pharmaceutical market. These include the significant research and development costs involved in creating targeted cancer treatments, the relatively smaller patient population compared to common illnesses, and the lack of a generic equivalent. While a generic version of osimertinib exists outside the U.S., it is not yet available in the U.S. market, keeping the brand-name price high.
The Role of Insurance in Determining Your Cost
For most patients, the retail price of Tagrisso is not what they pay out of pocket. Health insurance plays a critical role in managing the cost, although the final expense can still be significant. Tagrisso is typically placed on a plan's highest drug tier, known as the 'specialty tier'. This means that after a deductible is met, patients may still be responsible for a percentage of the drug's cost (co-insurance) or a high copay. Most insurance plans, including Medicare Part D and Medicare Advantage, cover Tagrisso, but often require prior authorization.
How Co-Pay and Co-Insurance Work
- Co-pay: A fixed amount you pay for a covered prescription, often ranging from $100 to over $500 for a specialty drug.
- Co-insurance: A percentage of the total cost that you are responsible for, such as 20% or 30%, which can still amount to a substantial monthly payment for an expensive drug like Tagrisso.
Financial Assistance and Savings Programs
For many patients, especially those with commercial insurance, the key to affordability is through financial assistance programs. These programs can significantly reduce or even eliminate out-of-pocket costs.
Manufacturer Patient Savings Program
AstraZeneca, the manufacturer of Tagrisso, offers the TAGRISSO Patient Savings Program. This program is specifically for commercially insured patients and aims to help with copayment, deductible, and co-insurance expenses. It can potentially lower the monthly cost to as little as $0 for eligible patients, with an annual cap on assistance that can be up to $26,000. Crucially, this program is not available for patients with government-funded insurance like Medicare or Medicaid.
Independent Charitable Foundations
For patients who do not qualify for the manufacturer's program, or who are covered by government insurance, independent non-profit organizations can offer assistance. These foundations have specific eligibility criteria, often related to income and diagnosis, and can provide grants to help cover copayments and other costs. Notable examples include the Patient Access Network (PAN) Foundation and the HealthWell Foundation.
Government Programs
Patients with Medicare Part D may be able to enroll in a Low Income Subsidy (LIS) or "Extra Help" program, which can significantly lower prescription drug costs. State Medicaid programs also provide assistance to those who qualify based on income and other factors.
Pharmacy Coupons and Discount Cards
Online pharmacies and websites like WebMDRx and Drugs.com offer coupons and discount cards that can reduce the cash price for uninsured patients or even for those with insurance whose plan copay is higher than the discounted cash price. However, even with these discounts, the out-of-pocket cost remains high.
International Options
Some patients explore purchasing Tagrisso from certified international pharmacies, where prices may be lower. This option comes with significant risks regarding legality and product authenticity and should be approached with extreme caution after consulting with a healthcare provider and pharmacist. It is not recommended for most patients.
Comparison of Tagrisso 40mg Costs
| Payment Scenario | Estimated Monthly Cost (30-day supply) | Key Considerations |
|---|---|---|
| Retail Cash Price | ~$5,800 to $5,900 | No insurance, highest cost. |
| Commercial Insurance (with copay card) | $0 to Low Copay | Subject to eligibility, annual maximum benefit. |
| Commercial Insurance (standard copay) | High Copay ($100-$500+) or Co-insurance | Cost depends on plan design, deductible, and out-of-pocket maximum. |
| Medicare Part D (standard) | Varies, potential high cost in "Donut Hole" | Cost depends on plan, deductible, and coverage phase. |
| Medicare Part D (with Extra Help) | Very low or fixed copay | Subject to income and resource limits. |
| Independent Foundation Grant | Can lower copay to $0 or manageable amount | Must meet foundation-specific eligibility criteria. |
| International Pharmacies | Potentially lower, e.g., ~$10,500 for a 90-day supply | Legal and safety risks; not recommended. |
Conclusion: Navigating the Financial Landscape
While the sticker price of Tagrisso 40mg is daunting, most patients do not pay the full retail cost. The majority of commercially insured patients with the help of the manufacturer's program pay little to nothing out-of-pocket for their prescription. For those with Medicare, Medicaid, or no insurance, a patchwork of programs exists to provide relief, though they may require more effort to navigate. The key is to be proactive and engage with resources like the manufacturer's support program, independent foundations, and government programs to find the best pathway to affordability. Patients and their families should work closely with their oncology team and a financial counselor to create a personalized strategy for managing the costs associated with Tagrisso.
For more information on financial support, consider visiting the AstraZeneca Access 360 website.
