Zolgensma (onasemnogene abeparvovec-xioi) is a brand-name prescription medication. The Food and Drug Administration (FDA) has approved it to treat spinal muscular atrophy that’s due to certain genetic changes. The drug is for use in children younger than age 2 years.
For more information about Zolgensma’s uses, refer to this article.
Here are some details about Zolgensma:
- How it’s given: one-time intravenous infusion by a healthcare professional
- Biosimilar version: not available
Read on to learn about Zolgensma injections and cost, as well as how to save money on prescriptions.
As with all medications, the cost of Zolgensma treatment can vary. Factors that may affect the price you’ll pay include:
- your child’s treatment plan
- your child’s insurance coverage
- the cost of the visit to a healthcare professional to receive the dose of Zolgensma
- whether Zolgensma has a savings program (see “Financial and insurance assistance” below)
To find out what the cost of Zolgensma will be for you, talk with your child’s doctor or insurance provider.
Below is information you may want to consider if you have insurance and receive Zolgensma.
Prior authorization. If you have insurance, your insurance company may require prior authorization before it covers Zolgensma. This means the company and your doctor will discuss Zolgensma in regard to your child’s treatment. The insurance company will then determine whether the medication is covered. If a drug requires prior authorization but your child starts treatment without the prior approval, you could pay the full cost of the medication. You can ask your insurance company whether Zolgensma requires prior authorization.
Type of insurance coverage. Zolgensma is given by your child’s doctor or another healthcare professional. If you have insurance, the price of Zolgensma may be billed through your primary health insurance instead of the prescription drug portion. This depends on your child’s insurance coverage and where your child receives Zolgensma, such as at a 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 Zolgensma.
How can I figure out Zolgensma’s cost per dose?
If your child is prescribed Zolgensma, you can talk with their doctor to find out about the cost you may pay. You may also be able to find out the drug’s price through the OneGene Program. Zolgensma is given as a one-time dose for treating spinal muscular atrophy.
Each child prescribed Zolgensma is enrolled in the OneGene Program. This program is offered by the drug’s manufacturer. The goal is to provide support and answer questions you, your insurance provider, and your child’s doctor may have. You may be able to find out how much you’ll pay for Zolgensma by asking a case coordinator in this program.
If you have additional questions, talk with your child’s doctor.
Why does Zolgensma cost so much?
Zolgensma is a type of treatment called gene therapy. Gene therapies have high prices because they’re costly to create. Zolgensma and other gene therapies also have extremely expensive research costs.
If you’d like to learn more about gene therapies, your child’s doctor can provide additional information.
Zolgensma contains the active ingredient onasemnogene abeparvovec-xioi and is available only as a brand-name gene therapy. Zolgensma does not come in a biosimilar version. A biosimilar medication is a drug that’s similar to a brand-name biologic drug or gene therapy (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 need financial support to pay for Zolgensma or if you need help understanding your insurance coverage, help is available. For example:
- A program called Zolgensma CopayAssist is available for Zolgensma through the OneGene program. For more information and to find out if you’re eligible for support, call 855-441-4363 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 Zolgensma, you may still have some questions. Talk with your doctor or pharmacist, who can provide personalized guidance about cost issues related to Zolgensma. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you would pay for Zolgensma.
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 Zolgensma, refer to this article.
- Information about spinal muscular atrophy. For more information about spinal muscular atrophy, see our list of articles on genetics.
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.