is dupixent covered by insurance

Dupixent (dupilumab) is a prescription drug that’s used to treat several conditions, including asthma, eczema, and more. Dupixent’s cost may depend on factors such as your dosage, whether you have health insurance, and the pharmacy used.

Keep reading for information about the cost of Dupixent and how to save money on prescriptions. For more details on Dupixent, see this in-depth article.

How much does Dupixent cost?

The price you pay for Dupixent can vary. Your cost may depend on your treatment plan and your insurance coverage (if you have it).

It will also depend on how much you have to pay for an office visit with your doctor if you receive Dupixent at your doctor’s office.

To find out how much you’ll pay for Dupixent, talk with your doctor or insurance provider.

FAQ about cost and Dupixent

Below are answers to some frequently asked questions about Dupixent and cost.

Is the cost of Dupixent much higher without insurance than with insurance?

It’s possible. What you pay for Dupixent can depend on several factors. Your cost may be higher if you pay out of pocket, but the cost can also vary based on your insurance coverage.

Other factors that affect the price you pay include:

  • how often you receive Dupixent injections
  • whether you receive treatments at your doctor’s office or give them to yourself at home
  • whether you have a set copay (your share of the cost) with insurance
  • whether you use the Dupixent MyWay Copay Card

To learn more about the cost of Dupixent, ask your doctor. They can provide more information about the price you’ll pay based on your dosage and other factors.

Why is Dupixent so expensive?

Dupixent is only available as a brand-name drug. It’s also a biologic drug, which means it’s made from parts of living organisms. But it’s not available as a biosimilar. Biosimilars are like generic versions of biologic drugs.

In general, biologic drugs cost more than biosimilar drugs. To learn more about the cost difference between these types of drugs, see the “Is Dupixent available as a generic or biosimilar?” section below.

Dupixent’s cost may also be higher because it’s an injectable medication and is available through select specialty pharmacies only. And in some cases, you need to visit your doctor to receive a dose.

To learn more about ways to save on the cost of Dupixent, see the “Can I get help paying for Dupixent?” section below.

How can I lower my long-term drug costs?

If you use Dupixent long term and you’re able to give yourself the injections at home, you may be able to lower Dupixent’s cost in the following way:

  • Look into getting a 90-day supply of your medication: You may be able to get a 90-day supply of Dupixent if approved by your insurance company. This could help lower your monthly cost of Dupixent. Talk with your doctor or insurance provider or see the manufacturer’s website for more information on how you could lower your cost of Dupixent per month.

Is Dupixent available as a generic or biosimilar?

Dupixent only comes as a brand-name drug. It’s a biologic drug, which means it’s made from parts of living organisms. Dupixent isn’t available in a biosimilar form. (Biosimilars are like generic drugs. But unlike generics, which are made for nonbiologic drugs, biosimilars are made for biologic drugs.)

WHY IS THERE SUCH A COST DIFFERENCE BETWEEN BIOLOGIC DRUGS AND BIOSIMILAR DRUGS?

Biologic drugs can be expensive because of the research and testing needed to ensure their safety and effectiveness. The manufacturer of a biologic drug can sell it for up to 12 yearsTrusted Source. When the biologic drug’s patent expires, other drug makers can create biosimilar versions. This competition in the market may lead to lower costs for biosimilars. And because biosimilars are very similar to biologic drugs, they don’t need to be studied again. This can also lead to lower costs for biosimilars.

Can I get help paying for Dupixent?

If you need help covering the cost of Dupixent or understanding your insurance, check out these websites:

On these sites, you can find insurance information, details on drug assistance programs, and links to savings cards and other services.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You may also be eligible for a savings card called the Dupixent MyWay Copay Card. This could save you money on your copay for Dupixent if you have insurance.

What should my next steps be?

If you still have questions about the cost of Dupixent, talk with your doctor or pharmacist. They may be able to give you a better idea of what you’ll pay for this drug. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you’d pay for Dupixent.

Examples of questions you may want to ask your doctor or insurance provider include:

  • Are there other lower-cost medications that could treat my condition?
  • Does the cost of Dupixent depend on my dosage?
  • Is my Dupixent prescription less expensive if I give myself the injections?

To learn more about Dupixent, see these articles:

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Dupixent is covered by some insurance plans including Medicare and Medicaid. However, due to the cost, most health plans may require prior authorization, a letter of medical necessity, or step therapy. Patients should not be surprised if the insurance company initially refuses to cover the prescription.

Even with insurance, the out-of-pocket expense could be very high depending on the plan’s copay and deductible. About 68% of patients with commercial insurance and 71% of Medicare Part D consumers pay less than $100 each month, according to Sanofi, the manufacturer. Sanofi offers a Dupixent MyWay copay card to some patients with commercial insurance, but it has eligibility requirements and a yearly maximum of $13,000.

How much does Dupixent cost without insurance?

The average monthly retail price of Dupixent is $4,910 per 2, 2 mL of 300 mg/2 mL prefilled syringes. Depending on the dose, uninsured patients can expect to pay up to $59,000 per year for Dupixent treatment. 

Dupixent is the only monoclonal antibody approved by the FDA to treat atopic dermatitis and eczema. For asthma or nasal polyposis, however, there are other monoclonal antibodies that work like Dupixent. Unfortunately, they are all brand-name injections that are also expensive, and some may only be available at specialty pharmacies. Additional fees, such as infusion costs, may also be involved. 

For patients who can’t afford Dupixent, there are less expensive alternatives. For asthma, these include high-dose corticosteroid inhalantslong-acting beta-agonists (LABAs), and oral leukotriene modifiers. For atopic dermatitis, alternatives include oral and topical corticosteroids as well as non-pharmaceutical therapies such as light therapy or biofeedback. 

There are no over-the-counter drugs or supplements that can effectively substitute for prescription asthma, nasal polyps, or atopic dermatitis treatments.

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs. The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see updated drug prices.

How to get Dupixent without insurance

Very few people can pay for a prescription drug like Dupixent without insurance. Even those with insurance may find themselves paying several thousand dollars a month for their prescription. Reducing that cost through whatever means is the only way most people will be able to take the drug. Here are a few options.

1. Use a SingleCare discount card

The most foolproof way to reduce out-of-pocket costs for Dupixent is a free coupon from SingleCare. A SingleCare savings card could reduce the cost of Dupixent without insurance as much as $1,600 per month. You can also use SingleCare on Dupixent alternatives to save even more money. 

2. Ask the prescriber for a free sample

Your healthcare provider may have enough free samples to cover one month of treatment. If not, request them from the manufacturer. This will give you a chance to try the medicine and buy extra time to find ways to pay for the prescription in the following months.

3. Ask the prescriber about patient assistance

Uninsured patients can apply to the manufacturer’s patient assistance program, the Dupixent MyWay program. Eligible patients may receive Dupixent for free or at a reduced cost. The manufacturer can provide additional information and enrollment forms.

4. Switch medications

It’s unlikely that a healthcare professional would prescribe an extremely high-priced medication like Dupixent if other drugs hadn’t already been tried. Still, get medical advice and prescribing information from a healthcare professional about any Dupixent alternative that hasn’t been tried yet. 

5. Get health insurance

Even a low-deductible plan will be less expensive than the cost of Dupixent. First, make sure the health plan will cover your Dupixent prescription. Second, research the plan’s rules for getting a Dupixent prescription accepted. Insurance providers may require step therapy or prior authorization before covering Dupixent. Finally, compare the plan’s premium, deductible, and copay to the price of Dupixent without insurance. Don’t just buy any plan. Make sure you’re investing in a plan that will reduce overall healthcare costs.

6. Find out if you qualify for Medicaid

If the combined cost of health insurance premiums and the out-of-pocket costs are still too high, see if you qualify for Medicaid. Consult your state’s Medicaid website for eligibility requirements before applying.

7. Apply to Medicare’s Extra Help program

If you’re eligible for Medicare, you may also qualify for Extra Help. Extra Help is a low-income subsidy that helps reduce Medicare Part D costs, including copays for prescriptions like Dupixent, and eliminates late enrollment fees.

8. Look for the lowest price

Even the cheapest medications like aspirin can cost more at one pharmacy than another. For drugs that cost thousands of dollars, finding the lowest price can save hundreds of dollars, so it pays to compare prices.

Dupixent (dupilumab) is a brand-name biologic that’s prescribed for eczema, asthma, and more. It’s available in single-dose prefilled syringes and pens. The cost of Dupixent with and without insurance can depend on several factors, such as whether the drug has a savings program.

Specifically, Dupixent is approved to treat the following conditions:

Dupixent is given as a subcutaneous injection.

Read on to learn about Dupixent and cost, as well as how to save money on prescriptions. For more information about Dupixent’s uses, refer to this article.

Dupixent price

As with all medications, the price of Dupixent can vary. Factors that may affect the Dupixent injection price you’ll pay include:

  • your treatment plan
  • your insurance coverage
  • the pharmacy used
  • whether Dupixent has a savings program (see the “Financial and insurance assistance” section below)

To find out the Dupixent injection cost you’ll likely pay, talk with your doctor, pharmacist, or insurance provider.

Note: Dupixent may be more expensive in the United States than in other countries. This is based on the drug and insurance regulations in each country. Talk with your doctor and insurance provider if you need a prescription filled in a different country.

Common questions about cost and Dupixent

Here are answers to some frequently asked questions about drug cost and Dupixent.

How can I determine the cost of Dupixent with and without insurance?

If you have a prescription for Dupixent, your pharmacist can tell you the retail price with insurance and without insurance.

Even if you have insurance, you may have to pay the out-of-pocket cost for Dupixent according to your plan’s details. The manufacturer assistance program for Dupixent may be able to help you pay the out-of-pocket cost if you are eligible for the program.

Talk with your insurance provider to determine the exact cost of Dupixent under your plan. They can also tell you if you should fill your prescription at a specific pharmacy to get the lowest cost.

Your insurance provider can tell you what the cost of Dupixent would be per month, per year, and per dose. The annual cost of Dupixent may vary every year based on insurance plan changes, drug price changes, and whether you are eligible for assistance programs.

Do Dupixent’s costs vary based on whether it’s used for eczema, rhinosinusitis with nasal polyps, or asthma?

It’s possible. Because the dosage is different for different conditions, you may need a different amount of the drug. This will likely change the cost, based on the number of syringes or pens you need for your dose.

If you have questions about the cost of Dupixent for your condition, talk with your pharmacist or insurance provider.

How much does the 300-mg/2-mL shot of Dupixent cost?

The cost of the 300-milligrams per 2-milliliters (mg/mL) injection of Dupixent will vary based on several factors. The cost of Dupixent may vary based on the strength and dosage form you use. Talk with your insurance provider or pharmacist for specific cost information.

Brand-name vs. biosimilar drugs

Dupixent is only available as a brand-name drug. Dupixent contains the active ingredient dupilumab, which is a biologic drug. It doesn’t come in a biosimilarTrusted Source version. A biosimilar medication is a drug that’s similar to a brand-name medication (the parent drug).

Biologics are made from living cells. It’s not possible to make an exact copy of these drugs. A generic, on the other hand, refers to medications made from chemicals. A generic is an exact copy of the active drug in a brand-name medication.

Biosimilars are considered to be just as safe and effective as their parent drug. And like generics, biosimilars tend to cost less than brand-name medications.

WHY ARE COSTS DIFFERENT FOR BRAND-NAME DRUGS VS. GENERIC DRUGS?

Brand-name drugs can be expensive because of the research needed to test their safety and effectiveness. The manufacturer of a brand-name drug can sell it for up to 20 years. When the brand-name drug’s patent expires, multiple manufacturers can create generic versions. This marketplace competition may lead to lower costs for generics. Also, because generics contain the same ingredients as brand-name drugs, they don’t require the same costly testing.

Ways to reduce long-term drug costs

If you take Dupixent long term, you may be able to lower its cost in the following way:

Getting a 3-month supply

You may be able to get a 90-day supply of Dupixent. If approved by your insurance company, getting a 90-day supply of the drug could reduce your number of trips to the pharmacy and help lower the cost. If you’re interested in this option, check with your doctor, pharmacist, or insurance provider.

Financial and insurance assistance

If you need financial support to pay for Dupixent, or if you need help understanding your insurance coverage, help is available. For example:

  • A program called Dupixent MyWay provides a manufacturer coupon copay card. For more information and to find out if you’re eligible for support, call 844-387-4936 or visit the program website.
  • Some websites provide details about drug assistance programs, ways to make the most of your insurance coverage, and links to savings cards and other services. Two such websites are:

To learn more about saving money on prescriptions, check out this article.

Next steps

Now that you’ve learned about cost and Dupixent, you may still have some questions. Talk with your doctor or pharmacist, who can provide personalized guidance about cost issues related to Dupixent. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you would pay for Dupixent.

Here are some other resources you may find helpful:

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Do not use if you are allergic to dupilumab or to any of the ingredients in DUPIXENT®.

Before using DUPIXENT, tell your healthcare provider about all your medical conditions, including if you:

  • have eye problems.
  • have a parasitic (helminth) infection.
  • are scheduled to receive any vaccinations. You should not receive a “live vaccine” right before and during treatment with DUPIXENT.
  • are pregnant or plan to become pregnant. It is not known whether DUPIXENT will harm your unborn baby.
  • are breastfeeding or plan to breastfeed. It is not known whether DUPIXENT passes into your breast milk.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.

Especially tell your healthcare provider if you are taking oral, topical, or inhaled corticosteroid medicines or if you have CRSwNP and asthma and use an asthma medicine. Do not change or stop your corticosteroid medicine or other asthma medicine without talking to your healthcare provider. This may cause other symptoms that were controlled by the corticosteroid medicine or other asthma medicine to come back.

DUPIXENT can cause serious side effects, including:

  • Allergic reactions. DUPIXENT can cause allergic reactions that can sometimes be severe. Stop using DUPIXENT and tell your healthcare provider or get emergency help right away if you get any of the following signs or symptoms: breathing problems or wheezing, swelling of the face, lips, mouth, tongue, or throat, fainting, dizziness, feeling lightheaded, fast pulse, fever, hives, joint pain, general ill feeling, itching, skin rash, swollen lymph nodes, nausea or vomiting, or cramps in your stomach-area.
  • Eye problems. Tell your healthcare provider if you have any new or worsening eye problems, including eye pain or changes in vision, such as blurred vision. Your healthcare provider may send you to an ophthalmologist for an eye exam if needed.
  • Inflammation of your blood vessels. Rarely, this can happen in people with asthma who receive DUPIXENT. This may happen in people who also take a steroid medicine by mouth that is being stopped or the dose is being lowered. It is not known whether this is caused by DUPIXENT. Tell your healthcare provider right away if you have: rash, chest pain, worsening shortness of breath, or a feeling of pins and needles or numbness of your arms or legs, or persistent fever.
  • Joint aches and pain. Some people who use DUPIXENT have had trouble walking or moving due to their joint symptoms, and in some cases needed to be hospitalized. Tell your healthcare provider about any new or worsening joint symptoms. Your healthcare provider may stop DUPIXENT if you develop joint symptoms.

The most common side effects in patients with chronic rhinosinusitis with nasal polyposis include injection site reactions, eye and eyelid inflammation, including redness, swelling, and itching, sometimes with blurred vision, high count of a certain white blood cell (eosinophilia), trouble sleeping (insomnia), toothache, gastritis and joint pain (arthralgia).

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of DUPIXENT. Call your doctor for medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Use DUPIXENT exactly as prescribed by your healthcare provider. It’s an injection given under the skin (subcutaneous injection). Your healthcare provider will decide if you or your caregiver can inject DUPIXENT. Do not try to prepare and inject DUPIXENT until you or your caregiver have been trained by your healthcare provider.

Please see accompanying full Prescribing Information including Patient Information.

Indication

DUPIXENT is a prescription medicine used with other medicines for the maintenance treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP) in adults whose disease is not controlled. It is not known if DUPIXENT is safe and effective in children with chronic rhinosinusitis with nasal polyposis under 18 years of age.

Key points

  • The largest US commercial health plans vary in how they cover dupilumab for moderate-to-severe atopic dermatitis.
  • Plans’ clinical coverage criteria have become more consistent over time.
  • Fewer plans are now requiring that a dermatologist prescribe dupilumab compared to 2017.
  • Plans step therapy requirements vary widely, with the number of “steps” required before patients can access dupilumab ranging from one to five.

In this blog we examine how commercial health plan coverage of dupilumab (Dupixent®) for the treatment of moderate-to-severe atopic dermatitis has evolved since the product’s FDA approval in 2017. FDA also approved dupilumab for asthma (2018) and chronic rhinosinusitis with nasal polyposis (2019). Atopic dermatitis affects roughly 15% of children and 10% of adults in the US.1,2 The majority of children suffer from a mild form of the disease; moderate-to-severe atopic dermatitis is more common in adults.3,4 Dupilumab is widely regarded as a safe and effective treatment.5 Dupilumab is currently the only available biologic therapy available for moderate-to-severe atopic dermatitis, although it will soon face competition.6

The Tufts-CEVR Specialty Drug Evidence and Coverage (SPEC) Database, contains detailed information from 2017-2021 on how plans cover specialty drugs and products. SPEC quantifies payer behavior by translating publicly available specialty drug coverage policies into structured, analysis-ready data.

We used SPEC to scrutinize how the included US commercial health plans (representing roughly 150 million lives; 60% of the commercial market) covered dupilumab for moderate-to-severe atopic dermatitis from 2017 through 2021. We focus on three broad categories of plan imposed utilization management criteria:

  1. Clinical requirements – Plan requires a patient to meet specific clinical criteria, e.g., to have experienced symptoms of particular severity or duration, before they can access dupilumab.
  2. Prescriber requirements – Plan requires dupilumab to be prescribed by a dermatologist, or in consultation with a dermatologist.
  3. Step-therapy protocols – Plan requires a patient to try one or more alternative treatments, and experience treatment failure, before they can access dupilumab.

Clinical criteria

When health plans imposed clinical criteria in their coverage policies they tended to require one or more of the following:

  1. ≥10% body surface area (BSA) affected (or involvement of sensitive areas of the body)
  2. Particular symptoms to be present, e.g., erythema, edema, lichenification, crusting and oozing
  3. The patient’s symptoms have been present for ≥3 years
  4. Investigator’s Global Assessment (IGA) score of 3 or 4 (the overall assessment of AD lesions on a severity scale of 0 to 4)

As important context, the requirement for a minimum BSA involvement of ≥10% and an IGA score ≥3 were among dupilumab’s FDA registration studies’ inclusion criteria; the ≥3 year symptom duration and requirement that certain symptoms be present were not.

Health plans’ clinical requirements have changed over time (Figure 1). Notably, the percentage of plans requiring eligible patients to have ≥10% BSA affected (or have sensitive body area involvement) increased from 30% in 2017 to 57% in 2021. Conversely, the percentage of plans requiring that a patient’s symptoms have been present for ≥3 years before being eligible for dupilumab decreased from 30% in 2017 to 0% in 2021. One plan required a patient have an IGA score ≥3 in their 2017-2019 coverage policies, but removed the requirement in 2020. One other plan required that the patient be suffering from particular symptoms, e.g., erythema, edema, lichenification, crusting and oozing, at each of the five time points.

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