Benlysta and cost

As with all medications, the cost of Benlysta 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 Benlysta*
• whether Benlysta has a savings program (see the “Financial and insurance assistance” section below)
• the form of Benlysta your doctor prescribes

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

* This will depend on the form of Benlysta your doctor prescribes. With Benlysta for subcutaneous injection, you may self-inject the drug at home. To learn more about Benlysta forms and dosage, see this article.

Benlysta contains the active ingredient belimumab, 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 Benlysta 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 Benlysta. 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

Benlysta 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 a health insurance plan, 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 Benlysta, or if you need help understanding your insurance coverage, help is available. For example:

• A program called the Benlysta Copay Program is available. For more information and to find out if you’re eligible for support, call 800-741-0375 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:
  • Medicine Assistance Tool
  • NeedyMeds

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

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

How much does Benlysta cost with insurance vs. without it?

What you pay for Benlysta if you have insurance compared to what you’d pay without it depends on several factors.

Factors that could affect what you pay for this drug without insurance include:

• your dosage and treatment plan
• the form of the drug you’re prescribed (such as the IV infusion or subcutaneous injection)
• the quantity you’re prescribed (such as a 90-day or 30-day supply)
• the pharmacy you use
• whether you apply and qualify for any available savings programs

These same factors may affect your cost for Benlysta if you have insurance. The cost with insurance will also depend on your specific plan benefits and any prior authorization requirements you have for drug coverage. (For details about this, see the “Insurance considerations” section below.)

To learn more about what you’d pay for Benlysta with or without insurance, talk with your doctor, pharmacist, or insurance provider (if you have one).

Is Benlysta covered by Medicare?

It may be. You can call your Medicare plan provider to learn whether your particular plan covers the cost of this drug. There are many types of Medicare plans, so your coverage and what you pay for prescriptions will be based on your particular plan’s benefits.

The total price you pay for Benlysta may also depend on the cost to receive infusions at your doctor’s office or clinic. You may also need to obtain prior authorization before your plan will cover the cost of this medication.

Your doctor may also provide information about your cost for Benlysta if you have Medicare.

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

Prior authorization: If you have insurance, your insurance company may require prior authorization before it covers Benlysta. This means the company and your doctor will discuss Benlysta 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 Benlysta requires prior authorization.

Type of insurance coverage: Benlysta IV infusion is given by your doctor or another healthcare professional. If you have insurance, the price of your Benlysta infusion 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 Benlysta 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.

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

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 Benlysta, refer to this article.
• Dosage: Learn about Benlysta and dosage by viewing this article.
• Side effects: For details about Benlysta’s side effects, see this article. You can also look at the Benlysta prescribing information.
• Information about lupus: For more information about lupus, see our list of lupus 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.