Herceptin and cost

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

To find out what the cost of Herceptin 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 Herceptin.

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

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

Herceptin contains the active drug trastuzumab. It’s available in several biosimilar forms. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Biosimilar forms of Herceptin include:

• Herzuma (trastuzumab-pkrb)
• Kanjinti (trastuzumab-anns)
• Ogivri (trastuzumab-dkst)
• Ontruzant (trastuzumab-dttb)
• Trazimera (trastuzumab-qyyp)

Biosimilars are considered to be just as safe and effective as their parent drug. And like generics, biosimilars tend to cost less than brand-name medications.

If your doctor has prescribed Herceptin and you’re interested in receiving a biosimilar form instead, talk with your doctor. They may have a preference for one version or another. You’ll also need to check with your insurance provider, as it may only cover one version.

To find out how the cost of biosimilar drugs compares with the cost of Herceptin, talk with your doctor, pharmacist, or insurance provider.

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 receive Herceptin long term, you may be able to lower its cost.

If you don’t have health insurance, talk with your doctor. They can advise whether you qualify for certain financial assistance options.

If you need financial support to pay for Herceptin, or if you need help understanding your insurance coverage, help is available. For example:

• The drug’s manufacturer offers multiple assistance programs that may help lower the cost of Herceptin. For more information and to find out if you’re eligible for support for any of these programs, call 888-249-4918 or visit the manufacturer’s 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 Herceptin.

How can I save money on my Herceptin prescription if I have insurance coverage?

The drug’s manufacturer offers the Genentech Oncology Co-pay Assistance Program. Depending on the type of insurance you have, you may qualify for coverage. To find out if you’re eligible, visit the program website.

For more information and other recommendations to lower the cost of Herceptin, talk with your doctor or pharmacist.

Does Medicare cover Herceptin?

It’s possible that certain Medicare plans may cover the cost of Herceptin. For example, Medicare Part B provides coverage for most doctor’s office visits. Herceptin is an IV infusion that must be given by your doctor or another healthcare professional in their office. So, if you have a Medicare Part B plan, it’s possible that Herceptin may be covered.

To find out if your specific Medicare plan covers Herceptin, contact your plan provider. To learn more about Medicare coverage for cancer treatments, refer to this article.

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

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 Herceptin, refer to this article.
• Dosage. Learn about Herceptin and dosage by viewing this article.
• Side effects. For details about Herceptin’s side effects, see this article. You can also look at the Herceptin prescribing information.
• Information about cancer. For more information about cancer, see our cancer hub. For specific details about breast cancer, see our breast cancer 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.