Exondys 51 (eteplirsen) is a brand-name liquid solution that’s prescribed for Duchenne muscular dystrophy. The cost of the drug with and without insurance can depend on several factors.
Read on to learn about Exondys 51 and cost, as well as how to save money on prescriptions. If you’d like other information about Exondys 51, refer to this article.
As with all medications, the cost of Exondys 51 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 Exondys 51
- whether Exondys 51 has a savings program (see the “Financial and insurance assistance” section below)
To find out what the cost of Exondys 51 will be for you, talk with your doctor or insurance provider.
Below is information you may want to consider if you have insurance and receive Exondys 51.
Prior authorization. If you have insurance, your insurance company may require prior authorization before it covers Exondys 51. This means the company and your doctor will discuss Exondys 51 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 Exondys 51 requires prior authorization.
Type of insurance coverage. Exondys 51 is given by your doctor or another healthcare professional. If you have insurance, the price of your Exondys 51 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 Exondys 51 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.
Exondys 51 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 Exondys 51 long term, you may be able to lower its cost in the following ways.
Exondys 51 is given by a healthcare professional in their office. In addition, Medicare Part B covers the cost of some in-office medical services. For this reason, Medicare Part B may cover the cost of this drug.
To find out whether your Medicare plan covers Exondys 51 treatment, contact your doctor or your Medicare provider.
The drug’s manufacturer offers a savings program for Exondys 51. For more information, see the “Financial and insurance assistance” section below.
If you don’t have health insurance, talk with your doctor. They may be able to suggest payment options that could work for you.
If you need financial support to pay for Exondys 51, or if you need help understanding your insurance coverage, help is available. For example:
- A program called SareptAssist is available for Exondys 51. For more information and to find out if you’re eligible for support, call 888-SAREPTA (888-727-3782) 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:
To learn more about saving money on prescriptions with or without insurance, check out this article.
Now that you’ve learned about cost and Exondys 51, you may still have some questions. Talk with your doctor who can provide personalized guidance about cost issues related to Exondys 51. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you’d pay for Exondys 51.
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 Exondys 51, refer to this article.
- Dosage. Learn about Exondys 51 and dosage by viewing this article.
- A look at your condition. For more information about Duchenne muscular dystrophy, see our list of muscular dystrophy 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.