Epidiolex and cost

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

• your treatment plan
• your insurance coverage
• the pharmacy you use
• whether Epidiolex has a savings program (see the “Financial and insurance assistance” section below)

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

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

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

How does the price of Epidiolex compare with the price of CBD oil?

Unlike Epidiolex, cannabidiol (CBD) oil can be purchased without a prescription. Lots of companies make CBD oil, so the price can vary.

CBD oil typically does not undergo quality testing, so it may not be possible to know what strength or dosage you’re buying, even if it’s advertised as a specific strength or dosage. To learn more about the price of some CBD oils, see this article. Talk with your doctor before taking any over-the-counter products to treat your condition.

What you’ll pay for Epidiolex depends on whether your insurance covers this medication. It also may depend on where you fill your prescription and the amount your doctor prescribes for you. If you have questions about insurance coverage for Epidiolex, contact your insurance provider.

Is Epidiolex covered by Medicare?

It depends on your individual coverage under Medicare.

You can contact your Medicare provider to find out whether Epidiolex is covered under your plan. Your doctor or your pharmacist may also be able to check this information before giving you a prescription.

Epidiolex is only available as a brand-name drug. It doesn’t come in a generic version. A generic drug is an exact copy of the active drug in a brand-name medication.

Generics tend to cost less than brand-name drugs.

WHY ARE COSTS DIFFERENT FOR BRAND-NAME DRUGS VS. GENERIC DRUGS?

Brand-name drugs can be expensive because of the research needed to test their safety and effectiveness. The manufacturer of a brand-name drug can sell it for up to 20 years. When the brand-name drug’s patent expires, multiple manufacturers can create generic versions. This marketplace competition may lead to lower costs for generics. Also, because generics contain the same active ingredients as brand-name drugs, they don’t require the same costly testing.

If you take Epidiolex 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 Epidiolex. 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

Epidiolex 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 Epidiolex, or if you need help understanding your insurance coverage, help is available. For example:

• A program called the Epidiolex Copay Savings Program is available for Epidiolex. For more information and to find out whether you’re eligible for support, call 833-426-4243 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.

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

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 Epidiolex, refer to this article.
• Information about seizures. For more information about seizures, see our epilepsy and seizure hub.

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.