Exploring Cost-Saving Options for Cimzia, Along with Additional Information
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The cost of Cimzia, a brand-name biologic drug, can be influenced by several factors, making it essential for patients to understand these elements to manage their expenses.
Key Factors Affecting Cimzia’s Cost
- Insurance Coverage and Formulary Tier: Cimzia is often placed in higher cost tiers (specialty or non-preferred brand) in insurance plans, leading to higher copayments or coinsurance. Some plans also impose prior authorization, quantity limits, or step therapy, which can affect access and cost-sharing requirements.
- Pharmacy Type and Supply Quantity: Prices vary whether the drug is filled at retail pharmacies, mail order, or contracted networks, and if the supply is for 30 days vs. a longer supply (e.g., 90 days). Some plans limit supply duration, especially for specialty tiers.
- Manufacturer Pricing and Government Benchmarks: The government maintains drug price benchmarks like NADAC, but branded biologics like Cimzia typically have high wholesale acquisition costs (WAC) and do not have generic equivalents, keeping list prices high.
Ways to Lower Cimzia Cost
- Manufacturer Savings Card: For those with commercial insurance, Cimzia’s manufacturer offers a savings card that can reduce out-of-pocket costs to as low as $0. This card may help during insurance delays or denials as well.
- Patient Assistance Programs (PAPs): Cimzia provides a patient assistance program for uninsured or underinsured patients to receive the medication at no cost or reduced cost based on eligibility.
- Insurance Plan Choice and Formulary Navigation: Selecting insurance plans with better coverage or lower tiers for Cimzia or using contracted mail-order pharmacies may reduce costs. Understanding copay and coinsurance tiers is important.
Additional Tips
- If you don't have health insurance, your doctor or pharmacist may be able to suggest online pharmacy options.
- Websites like Medicine Assistance Tool and NeedyMeds provide details about drug assistance programs, ways to make the most of insurance coverage, and links to savings cards and other services.
In summary, Cimzia’s cost depends largely on insurance coverage tiers and pharmacy supply logistics, while manufacturer programs like savings cards and assistance programs provide key means to lower patient cost burdens. Additionally, understanding your insurance plan and navigating the formulary can help you make informed decisions about your treatment and costs.
[1] National Average Drug Acquisition Cost (NADAC) (2021). Retrieved from https://www.cms.gov/medicare-coverage-database/details/national-average-drug-acquisition-cost-nadac-rates [2] National Pharmaceutical Council. (2018). Specialty pharmacy: A guide for patients. Retrieved from https://www.npcnow.org/sites/default/files/2018-06/Specialty%20Pharmacy%20Guide%20for%20Patients.pdf [3] Cimzia. (n.d.). Cimzia savings program. Retrieved from https://www.cimzia.com/savings [4] National Alliance of State Pharmacy Associations. (2019). Specialty pharmacy: A consumer guide. Retrieved from https://www.naspa-rx.org/wp-content/uploads/2019/12/Specialty-Pharmacy-Consumer-Guide-2019.pdf
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