The cost of Enhertu (fam-trastuzumab deruxtecan-nxki) can vary based on several factors, including your insurance coverage. Coupons and drug savings programs can also lower the price you’ll pay for Enhertu.

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

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

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

Enhertu contains the active ingredient fam-trastuzumab deruxtecan-nxki, 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 reference 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 need financial support to pay for Enhertu, or if you need help understanding your insurance coverage, help is available. For example:

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

What is the cost of Enhertu without insurance?

The price you’ll pay for Enhertu if you don’t have insurance can vary based on several factors. But typically, the cost is higher for those without insurance.

There are other factors that could affect what you pay for this drug. These include:

  • whether you apply and qualify for any available savings programs
  • your dosage

To learn the exact cost you’d pay for this medication without insurance, ask your doctor or pharmacist. You may also want to check whether you qualify for any savings programs on Enhertu’s website.

Why is Enhertu so expensive?

Enhertu is only available as a brand-name medication. Branded drugs are usually more expensive than generics or biosimilars due to the years of testing they undergo, and the manufacturer usually has the right to exclusively sell the medication for a certain amount of time.

There may also be other costs associated with Enhertu treatment. For example, it’s usually administered by a healthcare professional at a doctor’s office or hospital — you can’t administer it yourself. This may mean you’ll incur travel costs to get your medication.

How does Enhertu’s cost compare with that of medications such as Herceptin or Tykerb?

The price you’d pay for Enhertu versus that of Herceptin (trastuzumab) or Tykerb (lapatinib) depends on various factors.

For instance, the form of the drug may affect its price. Enhertu and Herceptin are both available as intravenous (IV) infusions. Herceptin also comes in a form called Herceptin Hylecta, which is given by subcutaneous injection. Tykerb comes as an oral tablet. Typically, IV infusions or subcutaneous injections cost more than oral tablets.

There are additional factors that can affect your prescription cost, including:

  • the length of your treatment
  • whether there are payment assistance programs for your prescribed treatment
  • whether you’re paying out of pocket or have insurance

To learn more about the cost of Enhertu compared with other treatments for your condition, talk with your doctor, pharmacist, or insurance provider.

You may want to consider the following information if you have insurance and receive Enhertu.

Prior authorization: If you have insurance, your insurance company may require prior authorization before it covers Enhertu. This means the company and your doctor will discuss Enhertu in regard to your treatment. The insurance company will then determine whether the medication is covered.

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 Enhertu requires prior authorization.

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

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.