Orencia and cost

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

To find out what the cost of Orencia 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 Orencia.

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

Type of insurance coverage. Orencia may be given by your doctor or another healthcare professional. If you have insurance, the price of your Orencia 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 Orencia 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.

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

Is there a cost difference between Orencia IV infusion and subcutaneous injection?

There may be. Orencia IV infusions are given by a healthcare professional in their office. In contrast, Orencia subcutaneous injections may be given by you or a caregiver at home. If you have insurance, the cost of each form may depend on your specific plan.

If you have questions about which form is covered, contact your insurance provider.

Does Medicare cover Orencia?

It’s possible. Orencia may be given by you or a caregiver at home, or by a healthcare professional in their office. Depending on how you receive your doses, Orencia may be covered under certain Medicare Part D or Medicare Part B plans.

To learn more about the cost of Orencia with Medicare, contact your plan provider.

Because each Medicare plan is different, you’ll need to contact your Medicare provider to see if Orencia is covered.

Orencia contains the active ingredient abatacept, 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 Orencia 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 Orencia. 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

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

• A program called Orencia On Call is available for this drug. For more information and to find out if you’re eligible for support, call 800-ORENCIA (800-673-6242) 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 Orencia, you may still have some questions. Talk with your doctor or pharmacist, who can provide personalized guidance about cost issues related to Orencia. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you would pay for Orencia.

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 Orencia, refer to this article.
• Dosage. Learn about Orencia and dosage by viewing this article.
• Side effects. For details about Orencia’s side effects, see this article. You can also look at the Orencia prescribing information.
• A look at your condition. For more information about rheumatoid arthritis, see our rheumatoid arthritis 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.