Does Blue Cross Blue Shield cover Dupixent?

In this article:

• Does Blue Cross Blue Shield cover Dupixent?
• How much does Dupixent cost?
• How to check whether your Blue Cross Blue Shield plan covers Dupixent 
• How to save on Dupixent

In this article

• Does Blue Cross Blue Shield cover Dupixent?
• How much does Dupixent cost?
• How to check whether your Blue Cross Blue Shield plan covers Dupixent 
• How to save on Dupixent

Dupixent (dupilumab) is a brand-name monoclonal antibody drug that is approved by the Food and Drug Administration (FDA) to treat a variety of conditions. Its first approval was in 2017 for atopic dermatitis (eczema). More than 800,000 people around the world take Dupixent because it’s so effective. In clinical trials, it reduced itching for 68% of adults and adolescents and improved lesions for 82%. 

Specialty drugs like Dupixent are expensive to produce, and those costs are passed to consumers paying out of pocket. Insurance typically covers Dupixent, but coverage varies by plan and reason for taking. Here’s everything you need to know about Blue Cross Blue Shield (BCBS) coverage for Dupixent.

Does Blue Cross Blue Shield cover Dupixent?

In many cases, yes, BCBS will cover Dupixent. According to Navin Arora, DO, FAAD, founder of Borealis Dermatology, “Dupixent is usually a covered drug, as it is a one-of-a-kind medicine.” In fact, the Dupixent website claims that 99% of all adult and pediatric atopic dermatitis patients with private insurance are covered. But, that’s not a blanket statement for every BCBS health plan—and there are a lot of them.

The Blue Cross and Blue Shield Association isn’t a single insurance provider. It houses multiple separate licensees, each for a different state and each with its own range of insurance plans. For example, if you’re in Illinois, you might have insurance through Blue Cross Blue Shield of Illinois. While in California, the independent licensees of the Blue Cross are Anthem Blue Cross or Blue Shield of California.

Check with your specific company to confirm your Dupixent coverage. Sometimes, coverage isn’t as simple as showing your insurance card at the pharmacy. There are a few potential complications to keep in mind.

Reason for prescription

Along with moderate-to-severe atopic dermatitis (eczema), Dupixent is FDA approved to treat moderate-to-severe asthma, prurigo nodularis, eosinophilic esophagitis (EoE), chronic rhinosinusitis with nasal polyps (CRSwNP), and more recently, chronic obstructive pulmonary disorder (COPD). However, it’s shown some versatility in recent studies, so doctors might prescribe it off-label for other skin conditions that aren’t FDA approved. The issue is that many health plans won’t extend medical benefits for off-label prescriptions. Most only issue coverage for treatments approved by the FDA.

Prior authorization

Before covering a particular drug—particularly expensive brand-name ones like Dupixent—insurance providers might want to confirm that it’s medically necessary. This process is called prior authorization, and Dr. Arora says that it’s often required due to the cost of the medication. However, he says it ends up being approved around 95% of the time.

Prior authorization might require the healthcare provider to submit documentation of your symptoms, diagnosis, specialist visits, or other information. It also might include step therapy, which requires you to try other, less expensive treatments before moving on to Dupixent.

Drug tier

Every insurance plan has a drug list (formulary) that shows how it covers different over-the-counter and prescription drugs. These lists organize covered drugs into tiers, often with generics in tier 1 and brand-name or specialty drugs in the higher tiers. Their cost-sharing policies can vary based on the tier. Typically, the higher the tier, the more out-of-pocket costs the insured member will need to pay. Because Dupixent is a specialty drug, many formularies put it in one of the higher tiers, so it could come with higher copays and lower coinsurance.

Specialty drug requirements

Specialty drugs are expensive medications used to treat complex conditions. As a biologic—a drug made from living cells instead of synthetic chemicals—Dupixent carries this label. That means you can only get it at specialty pharmacies, and it often has a quantity limit, which restricts how much you can get at a time.

How much does Dupixent cost?

Without insurance coverage or any other discounts, the average cash price for Dupixent is $5,222 for 2, 2 mL pens. Fortunately, not everyone will have to pay that amount, especially if they get some help from BCBS.

But, even if your plan covers Dupixent, you’ll probably still have copayments. A 2023 employer health benefits survey from KFF showed that the average copay across insurance companies is $11 for first-tier drugs, $36 for second-tier drugs, $66 for third-tier drugs, and $1,256 for fourth-tier drugs.

Even though you’ll often find Dupixent in one of the higher tiers, Dr. Arora says he has found that copays for Dupixent range from $0–$25 per month. However, they might also be a lot higher—it all depends on your plan.

How much does Dupixent cost with Blue Cross Blue Shield?

It depends on your plan’s cost-sharing policies and drug tiers. The developers of Dupixent, Sanofi and Regeneron Pharmaceuticals, Inc., provide some insight into Dupixent’s average costs:

• Private and employer-provided plans: 60% of individuals whose private health insurance covers Dupixent pay $0–$100 per month, and the other 40% pay over $100 per month.
• Medicare beneficiaries: Of individuals whose Medicare Part D or Medicare Advantage plan covers Dupixent, 79% pay $0-$100 per month, and the remaining 21% pay $100 or more per month.
• Medicaid beneficiaries: Most people who have Medicaid will get Dupixent for $4–$9 per month.

These stats provide some helpful context, but you’ll need to check the details of your BCBS plan and talk to your pharmacist to determine Dupixent’s exact price for you.

How to check whether your Blue Cross Blue Shield plan covers Dupixent 

It’s all about the formulary. That’s where you’ll find all the crucial details about drug tier, prior authorization, step therapy, quantity limits, and more. Each BCBS licensee’s website usually houses all of their drug lists. Many of them have a “Resources” section, or a “Prescription Drugs” tab that can help you navigate to the formularies. You might also have success searching “Blue Cross Blue Shield drug lists” plus the name of your state.

Once you’ve got the drug list, just scroll down to find Dupixent, and it should tell you everything you need to know. If you have questions, or you’d just like to get the information from a person instead, you can always call the number on the back of your insurance card.

How to save on Dupixent

If you don’t have health insurance that covers Dupixent, there are other ways to save. Coupons from SingleCare, for example, can immediately take over $1,000 off your out-of-pocket cost, depending on your pharmacy. For example, you could pay $3,605 instead of $5,222 for a one-month supply. You can get these coupons for free by signing up for a prescription discount card. However, you can’t use them with insurance drug coverage, so check to see which option might save you more money in the long run.

There are several other ways to save on Dupixent, including a patient assistance program and a copay card from the drug’s manufacturer. Plus, there are several viable alternatives, which might be cheaper or covered more comprehensively under your BCBS plan.

Your healthcare provider can help determine which medication is the best treatment option for your unique case.