Does Medicaid cover Dupixent?

In this article:

• Does Medicaid cover Dupixent?
• Factors influencing Medicaid coverage for Dupixent
• How much does Dupixent cost?
• Cost of Dupixent with Medicaid
• How to get Dupixent with Medicaid
• Ways to get discounts on Dupixent without Medicaid

In this article

• Does Medicaid cover Dupixent?
• Factors influencing Medicaid coverage for Dupixent
• How much does Dupixent cost?
• Cost of Dupixent with Medicaid
• How to get Dupixent with Medicaid
• Ways to get discounts on Dupixent without Medicaid

Dupixent (dupilumab) is a prescription, injectable medication that targets specific proteins in the body that trigger inflammation, helping reduce symptoms and improving the quality of life for those with chronic inflammatory conditions. Dupixent was approved by the Food and Drug Administration (FDA) to treat atopic dermatitis (eczema), asthma, prurigo nodularis, eosinophilic esophagitis (EoE), chronic sinusitis with nasal polyps, and chronic obstructive pulmonary disease (COPD).

Without insurance, Dupixent can be difficult for people to afford. However, Medicaid might help cover the cost. Since Medicaid rules can differ, it’s important to understand how the program works and become familiar with your Medicaid plan details and drug formulary.

Does Medicaid cover Dupixent? 

Yes, Medicaid may cover Dupixent, but coverage is dependent on where you live and on specific criteria that need to be met. Medicaid is a program funded by both the federal government and individual states, and each state has its list of drugs (formulary) that Medicaid will pay for. Dupixent might be on your state’s formulary, but it’s essential to check with your local Medicaid program. If your state requires you to enroll in a managed Medicaid plan, you will need to check the specific plan’s formulary, as it may vary from other plans.

Factors influencing Medicaid coverage for Dupixent 

If Medicaid covers Dupixent in your state, there might be specific requirements you need to meet:

• Diagnosis: You will likely need a confirmed diagnosis of the condition Dupixent is FDA approved to treat, like eczema or asthma.
• Previous treatments: Some states might require you to try less expensive treatments before Medicaid approves Dupixent. This is called step therapy.
• Prior authorization: Your healthcare provider might need to get Medicaid approval before you can start using Dupixent. This process involves submitting details about your medical history and why Dupixent is necessary. 
• Income level: Your eligibility for Medicaid and how much coverage you get for Dupixent may also depend on your income level. Each state has income limits that determine whether you qualify for Medicaid benefits. Income level also may impact how much of a copay or coinsurance you’ll have to pay for prescription drugs.

For example, Wisconsin Medicaid’s preferred drug list considers Dupixent a nonpreferred drug that requires prior authorization. Additionally, the condition Dupixent is being used to treat must be FDA approved, and patients must meet the age requirements for each FDA-approved condition. For moderate to severe atopic dermatitis, for instance, the healthcare provider has to prove that the beneficiary has had a recent adverse history with a medium-potency topical corticosteroid. The beneficiary also has to be 6 months to 11 years old. If they’re 12 or older, they have to have tried a drug called Adbry first. 

How much does Dupixent cost?

Without insurance or Medicaid, Dupixent costs an average of $5,225 for 2, 2 mL pens, which is typically a 30-day supply. The price varies though, and most people don’t pay that price.

Several factors can affect the cost of Dupixent:

• Dosage: The cost may change based on how much you need, depending on what condition you’re treating and how your body responds to the medicine.
• Pharmacy: Prices vary between pharmacies, so checking different places for the best price is a good idea. You can do this online by looking up any medication on SingleCare’s drug price lookup tool. 
• Location: Drug prices are higher in some cities than others—even cities within the same state. 

Cost of Dupixent with Medicaid

The cost of Dupixent with Medicaid will depend on your state’s specific Medicaid plan. Medicaid usually helps lower the cost of prescription drugs, but you might still have some out-of-pocket expenses, such as:

• Copays: Some states require a small copayment for each prescription. This amount is usually low compared to the total price of the medicine. According to Sanofi and Regeneron Pharmaceuticals, Inc., Dupixent’s manufacturer, Medicaid patients often pay about $4–$9 per month.  
• Coinsurance: Sometimes, you might need to pay a percentage of the cost of the medicine. This percentage may depend on where you live, among other factors.

To determine what you might need to pay, check your state’s Medicaid drug list or contact your local Medicaid office.

How to get Dupixent with Medicaid

If you qualify for Medicaid and need Dupixent, follow these steps:

1. Talk to your healthcare provider. If your healthcare provider thinks Dupixent is worth trying for your condition, they’ll write a prescription.
2. Wait for any prior authorization requirements. If your state’s Medicaid program requires prior authorization, your healthcare provider must send the necessary paperwork to Medicaid. This could take about a week.
3. Fill the prescription: Dupixent has to be filled by a specialty pharmacy, and Medicaid may have its own specialty pharmacy it requires you to use for Dupixent. Once your healthcare provider sends your prescription to the pharmacy, the pharmacy will either have it delivered to your home or to your healthcare provider’s office, where they will teach you how to inject it. 

Ways to get discounts on Dupixent without Medicaid

If you don’t have Medicaid or if your state doesn’t cover Dupixent, there are still ways to save on the medicine. For example, the SingleCare prescription discount card provides digital coupons you can use at thousands of participating pharmacies. With a Dupixent coupon from SingleCare, you may pay $3,605 instead of $5,225 for two autoinjector pens. 

RELATED: How to save on Dupixent

If you can’t afford Dupixent, with or without Medicaid, be sure to talk to your healthcare provider. They may be able to recommend more affordable Dupixent alternatives to help manage your symptoms.