Is Copaxone Covered by Medicare?
- Find out if your Medicare Part D or Advantage plan can help pay for Copaxone, a prescription drug typically used to treat the symptoms of multiple sclerosis.
If you're living with multiple sclerosis (MS), your doctor may have prescribed Copaxone to help you manage the disease. Copaxone is an expensive drug, but Medicare Part D and Medicare Advantage prescription drug plans usually cover the medicine in its generic form, glatiramer acetate. In fact, according to GoodRx, 81% of Medicare prescription drug plans provide coverage for glatiramer acetate.
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What Is Copaxone?
Copaxone is a disease-modifying therapy that's known to stop the immune system from attacking the body's nervous system. The drug is available by prescription only and is usually injected subcutaneously. If you've been prescribed Copaxone, your doctor or their medical staff can show you how to self-administer your injections.
While your doctor while instruct you on your exact dosage, most patients receive one of two dosages:
- 20 mg/mL injected once daily
- 40 mg/mL injected three times per week
What Does Copaxone Cost?
Copaxone is an expensive medication. Before insurance, the price may be as much as $6,700 per 12 syringes. The generic is significantly less expensive but still costly at about $2,300 per 12 syringes.
If you have Medicare, you can expect your cost to drop significantly. You'll need to pay full price until meeting your deductible, if your plan requires one. The maximum Medicare deductible was set at $480 in 2022 and $505 in 2023.
After your Medicare deductible has been paid for the year, you only pay a copay. This copay amount depends on the plan you have. According to GoodRx, the copays for Copaxone vary widely, from $121 per 12 syringes to the same amount you would pay without insurance. The copays for glatiramer acetate on Medicare aren't nearly as high, but they can still be anything from $56 per 12 syringes to the same cost you would pay with no insurance.
Are There Coverage Restrictions on Copaxone?
Copaxone and its generic are very expensive, so insurers want to make sure you've exhausted your other options before they pay. Some Medicare plans may restrict the amount of medicine you can buy at once with your insurance or require your doctor to fill out a prior authorization form.
While you are in the coverage gap, or donut hole, stage, your plan may temporarily limit coverage on Copaxone or other medications, which might mean you need to pay more for your prescriptions at this time. The coverage gap starts when your total drug costs reach the annual limit, which in 2022 is $4,430. When you're in the coverage gap, you become responsible for paying 25% of the cost of your medications. That said, if you've paid $7,050 or more for prescription drugs while in your coverage gap, you'll enter catastrophic coverage, at which point you'll pay just 5% of your drug costs.