Gemtesa (vibegron) is a prescription medication used to treat the symptoms of overactive bladder (OAB) in adults, such as urinary incontinence, urgency, and frequency. It is a brand-name drug, and as of late 2025, no generic version is available, which contributes to its high cost. The price of Gemtesa is not uniform and can be heavily influenced by several factors, including your insurance coverage, the pharmacy you use, and whether you are eligible for any savings programs.
The retail price of Gemtesa without insurance
For individuals paying out-of-pocket, the cost of Gemtesa can be substantial. The average retail price for a 30-day supply of 30 tablets (75mg) typically falls in the range of $600 to $700, with some sources citing an average around $690. This price can vary slightly depending on the specific pharmacy, region, and any applicable pharmacy-specific cash prices. Without a savings strategy, this translates to a significant annual expense.
How insurance affects your out-of-pocket costs
Your insurance plan, whether commercial or through a government program like Medicare, will be the biggest factor determining your final cost. However, different plans have different rules, and even within the same type of plan, coverage can vary.
- Commercial Insurance: Many commercially insured patients can access substantial savings. The manufacturer offers a "Simple Savings Card" program that can reduce the monthly cost significantly. For those with commercial insurance where Gemtesa is covered, the out-of-pocket expense can be as low as $10 for a 30-day supply or even $0 for a 90-day supply until December 31, 2025. For commercially insured patients whose plans do not cover Gemtesa, the cost can be reduced to as little as $95 for a 30-day supply.
- Medicare: Gemtesa may be covered by some Medicare Part D and Medicare Advantage (MAPD) plans. However, it is often classified as a Tier 4 drug, which means a higher co-insurance payment is typically required. For 2025, the annual out-of-pocket maximum for covered drugs under Medicare is capped at $2,000, which can provide some predictability for total expenses. For low-income beneficiaries, the Medicare Extra Help program can dramatically reduce costs to a low, fixed co-pay.
Ways to save on Gemtesa
Managing the cost of a high-priced medication like Gemtesa requires exploring all available savings options. Several resources exist to help reduce your financial burden, regardless of your insurance status.
- Manufacturer Savings Card: The GEMTESA Simple Savings Program is a primary resource for commercially insured patients, offering tiered co-pay assistance. To enroll, you can apply online or by text message. This card cannot be used with government programs like Medicare or Medicaid.
- Pharmacy Discount Cards: Programs from companies like SingleCare and GoodRx provide free coupons that can be used at participating pharmacies to reduce the cash price. Depending on the pharmacy and the discount card, prices can drop significantly below the average retail cost. For some Medicare patients, a discount card might offer a lower price than their plan's co-pay.
- Patient Assistance Programs (PAPs): The manufacturer, Sumitomo Pharma, offers patient assistance programs for eligible individuals with limited income and resources. These programs can provide medication at a reduced cost or for free and are separate from the commercial savings card.
- Compare Pharmacies: Prices can vary by pharmacy. Using online tools from discount card providers allows you to compare the price of Gemtesa at local and mail-order pharmacies to find the lowest available rate.
Comparison of Gemtesa costs
| Payment Method | Typical 30-Day Cost | Details & Limitations |
|---|---|---|
| Retail Price (Without Insurance) | ~$600–$700 | Price can vary by pharmacy and region. No discounts applied. |
| Commercial Insurance (Covered) | ~$10 | Requires enrollment in the manufacturer's savings program. Max savings may apply. |
| Commercial Insurance (Not Covered) | ~$95 | Requires enrollment in the manufacturer's savings program for a reduced cost. |
| Pharmacy Discount Card | ~$430–$500 | Pricing depends on the specific card and pharmacy. May be better than some insurance plans. |
| Medicare Part D (Typical) | ~$200–$300 (before meeting deductible) | Varies by plan and formulary tier (often Tier 4). Not eligible for manufacturer coupon. |
| Medicare Extra Help | Up to $12.15 | Requires meeting low-income eligibility criteria for federal subsidy. |
| Manufacturer PAP | Varies (potentially free) | Depends on income, insurance status, and program eligibility. Cannot have Medicare/Medicaid. |
Conclusion
The price of Gemtesa is a major consideration for many patients managing overactive bladder symptoms. While the average retail price is high, your final cost is dependent on several factors, especially your insurance coverage. For those with commercial insurance, the manufacturer's Simple Savings program can be highly effective. If you have Medicare, your cost will depend on your plan's formulary, though the new $2,000 out-of-pocket cap for 2025 provides some financial protection. For those without insurance, or with high co-pays, pharmacy discount cards offer a valuable avenue for savings. Finally, patient assistance programs can provide crucial support for low-income individuals. The best strategy involves researching all options and consulting with your doctor or pharmacist to determine the most affordable path forward.
Visit the official Gemtesa website to learn more about the manufacturer's savings program.
