Cimzia and cost

As with all medications, the cost of Cimzia 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 Cimzia
• whether Cimzia has a savings program (see the “Financial and insurance assistance” section below)

To find out what the cost of Cimzia 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 Cimzia.

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

Type of insurance coverage. Cimzia may be given* by your doctor or another healthcare professional. If you have insurance, the price of your Cimzia 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 Cimzia 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.

* You’ll receive Cimzia doses by subcutaneous injection at your doctor’s office or clinic. However, your doctor may teach you how to self-inject the drug at home. To learn more about how Cimzia is given, see this article.

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

Does Medicare cover Cimzia?

Medicare may cover the cost of Cimzia treatment. It depends on your specific coverage. For example, Medicare Part B covers the cost of some drugs that a doctor gives in a healthcare setting. You’ll receive Cimzia doses in your doctor’s office or clinic when you first start treatment.

Medicare Part D provides coverage for prescription drugs that you get at the pharmacy. So ask your doctor whether you’ll continue to receive doses at their office or self-inject the drug at home. For details about how Cimzia is given, see this article.

To find out your cost for Cimzia, contact your Medicare representative. You can ask them whether you’ll owe a deductible or coinsurance payment. For more information about Cimzia and Medicare, see the “Next steps” section below.

Is there a cost difference depending on which condition Cimzia is being used to treat?

It’s possible Cimzia’s cost may differ depending on the condition you’re taking the drug to treat. What you’ll pay for Cimzia depends on many factors, including:

• your insurance coverage
• the pharmacy you use
• your dosage*
• where you receive your Cimzia doses†

If you have questions about the cost of Cimzia for your condition, talk with your insurance plan provider. They’ll explain whether your plan covers Cimzia and what you’ll pay.

* For details about Cimzia’s dosages for the conditions it treats, see this article.
† You’ll receive Cimzia doses by subcutaneous injection at your doctor’s office or clinic. However, your doctor may teach you how to self-inject the drug. To learn more about how Cimzia is given, see this article.

Cimzia contains the active ingredient certolizumab pegol, and it’s available only as a brand-name biologic drug. It doesn’t come in a biosimilar version. A biosimilar medication is 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 Cimzia 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 Cimzia. 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

Cimzia 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 Cimzia or help to understand your insurance coverage, help is available. For example:

• Programs called the CIMplicity Savings Program and CIMplicity Covered are available for Cimzia. For more information and to find out if you’re eligible for support, call 844-277-6853 or visit the program website.
• If you don’t have insurance coverage, the UCB Patient Assistance Program may be able to help. You can call 866-395-8366 or visit the program website to learn more.
• 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 Cimzia, you may still have some questions. Talk with your doctor or pharmacist, who can provide personalized guidance about cost issues related to Cimzia. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you’d pay for Cimzia.

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 Cimzia, refer to this article.
• Dosage. Learn about Cimzia and dosage by viewing this article.
• Side effects. For details about Cimzia’s side effects, see this article. You can also look at Cimzia’s prescribing information.
• Drug comparison. To find out how Cimzia and Humira compare, see this article.
• Information about your condition. For more information about your condition, visit our rheumatoid arthritis and psoriasis hubs. You can also see our lists of articles on some other conditions Cimzia is prescribed to treat:
  • Crohn’s disease
  • psoriatic arthritis
  • ankylosing spondylitis

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.