Actemra and cost

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

• your treatment plan
• your insurance coverage
• the pharmacy you use
• the cost of the visit to your healthcare professional to receive doses of Actemra
• whether Actemra has a savings program (see the “Financial and insurance assistance” section below)

To find out what the cost of Actemra will be for you, talk with your doctor, pharmacist, or insurance provider.

Insurance considerations

Below is information you may want to consider if you have insurance and receive Actemra.

Prior authorization. If you have insurance, your insurance company may require prior authorization before it covers Actemra. This means the company and your doctor will discuss Actemra in regard to your treatment. The insurance company will then determine whether to cover the medication. If a drug requires prior authorization but you start treatment without the prior approval, you could pay the full cost of the medication. You can ask your insurance company whether Actemra requires prior authorization.

Type of insurance coverage. Actemra is given by your doctor or another healthcare professional by subcutaneous injection or intravenous (IV) infusion. If you have insurance, the price of your Actemra doses may be billed through your medical coverage instead of the prescription drug portion of your insurance plan. This depends on your specific insurance plan and where you receive your Actemra doses, such as at your doctor’s office, an infusion clinic, or a hospital.* If you have questions about this process, contact your doctor or your insurance provider.

* For subcutaneous injections, your doctor can show you how to self-inject the medication at home. To learn more about taking Actemra, see this article.

Actemra contains the active ingredient tocilizumab, and it’s available only as a brand-name biologic drug. It doesn’t come in a biosimilar version. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Also, biosimilars tend to cost less than brand-name medications.

WHY ARE COSTS DIFFERENT FOR BIOLOGIC DRUGS VS. BIOSIMILAR DRUGS?

Biologic drugs can be expensive because of the research needed to test their safety and effectiveness. The manufacturer of a biologic drug can sell it for up to 12 years. When the biologic drug’s patent expires, multiple manufacturers can create biosimilar versions. This marketplace competition may lead to lower costs for biosimilars. Also, because biosimilars are very similar to biologic drugs, they don’t require the same costly testing.

If you take Actemra long term, you may be able to lower its cost in the following ways.

Getting a 3-month supply

You may be able to get a 90-day supply of Actemra. 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.

Using a mail-order pharmacy

Actemra may be available through a mail-order pharmacy. Using this type of service may help lower the drug’s cost and allow you to receive your medication without leaving home. Some Medicare plans may help cover the cost of mail-order medications. You may also be able to get a 90-day supply of the drug via mail order.

If you don’t have health insurance, talk with your doctor or pharmacist. They may be able to suggest online pharmacy options that could work for you.

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

• The Actemra Co-pay Program is available for Actemra. For more information and to find out if you’re eligible for support, call 855-722-6729 or visit the program website.
• If you don’t have insurance coverage, you may be eligible for the Genentech Patient Foundation. You can learn more on the program website or by calling 888-941-3331.
• 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:
  • Medicine Assistance Tool
  • NeedyMeds

To learn more about saving money on prescriptions with or without insurance, check out this article.

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

Here are some other resources you may find helpful:

• Medicare drug coverage. To learn about Medicare coverage for drugs, see these articles about Medicare prescription drug plans, drug coupons and Medicare, and the Medicare drug list.
• More details. For details about other aspects of Actemra, refer to this article.
• Dosage. Learn about Actemra and dosage by viewing this article.
• Side effects. For details about Actemra’s side effects, see this article. You can also look at the Actemra prescribing information.
• Information about your condition. For more information about your condition, see our rheumatoid arthritis hub and this list of pulmonary system articles.

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.