Kesimpta and cost

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

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

To find out what the cost of Kesimpta 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 Kesimpta. This means the company and your doctor will discuss Kesimpta 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 Kesimpta requires prior authorization.

Kesimpta contains the active ingredient ofatumumab, 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 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 Kesimpta 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 Kesimpta. 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.

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

• A program called Alongside Kesimpta is available for this drug. For more information and to find out if you’re eligible for support, call 855-KESIMPTA (855-537-4678) 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.

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

Is Kesimpta covered by Medicare?

It depends on the specific Medicare plan you have. For example, Medicare Advantage and Medicare Part D plans may have different copay options for the cost of brand-name drugs such as Kesimpta.

If you have questions about what you’ll pay for Kesimpta with Medicare, talk with your Medicare provider. To learn more about Medicare coverage for multiple sclerosis (MS) treatments, see this article.

How does the cost of Kesimpta compare with the cost of Ocrevus?

Kesimpta and Ocrevus (ocrelizumab) are both drugs that doctors may prescribe to treat relapsing forms of MS. The cost of Kesimpta versus Ocrevus depends on many factors.

The first dose of Kesimpta may be given by a healthcare professional in their office or clinic. Your doctor or pharmacist will teach you or a caregiver how to give your doses at home. However, Ocrevus is an intravenous (IV) infusion that can only be given by a healthcare professional. This difference may affect the cost of each drug.

The price of either drug also depends on whether you have insurance, as well as your specific insurance plan.

It’s important to note that each drug has a program that offers financial assistance for those who qualify. For details on Kesimpta’s financial assistance program, see “Financial and insurance assistance” above. For information on Ocrevus and cost, see this article.

To find out how much you’ll pay for Kesimpta versus Ocrevus, talk with your doctor, pharmacist, or insurance provider.

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

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 Kesimpta, refer to this article.
• Dosage. Learn about Kesimpta and dosage by viewing this article.
• Side effects. For details about Kesimpta’s side effects, see this article. You can also look at the Kesimpta prescribing information.
• Information about multiple sclerosis (MS). For more information about MS, see our multiple sclerosis 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.