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Key takeaways
Trelegy Ellipta is a brand-name drug that includes three medications used to prevent and control symptoms of COPD. It is not a rescue inhaler.
Without insurance, including Medicare and Medicaid, the average retail price of Trelegy Ellipta is $879 per inhaler.
State Medicaid plans are likely to cover Trelegy Ellipta, but coverage ultimately depends on the details of the plan.
The manufacturer of Trelegy Ellipta says that most Medicaid beneficiaries pay $4–$9 per inhaler, which is generally a month’s supply.
Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol) is a prescription medication used to treat chronic obstructive pulmonary disorder (COPD), which can involve emphysema, chronic bronchitis, or both. It is also prescribed for maintenance treatment of asthma in adults.
“Trelegy puts three commonly used inhaled medications into one inhaler,” explains Janet M. O’Mahony, MD, a Baltimore-area internal medicine physician with Mercy Medical Center in Baltimore, Maryland. As an inhaled corticosteroid, fluticasone furoate reduces inflammation in the airways. As bronchodilators, umeclidinium and vilanterol work slightly differently in the lungs. Umeclidinium is an anticholinergic that helps the muscles around the airways in the lungs stay relaxed to prevent shortness of breath, wheezing, and coughing. Vilanterol is a long-acting beta2-agonist that relaxes and opens air passages in the lungs to make it easier to breathe.
Although Trelegy Ellipta combines three long-acting medicines into one inhaler, making it easier for patients to take their medication, it will not relieve sudden breathing problems. Dr. O’Mahony says people with asthma and COPD would also be prescribed a rescue inhaler with a short-acting bronchodilator like albuterol. “This medication opens up the airways to the lungs and can give fast relief for wheezing and coughing caused by bronchial constriction,” she says. Rescue inhalers work quickly but leave the system within a couple of hours. Trelegy Ellipta is not meant to replace a person’s rescue inhaler and is not for people under 18 years old.
How much does Trelegy cost?
The average retail price for Trelegy Ellipta is $879 per aerosol powder inhaler. But that doesn’t mean you’ll necessarily pay that price. If you have health insurance, including Medicaid or Medicare, the price you pay is primarily determined by your prescription drug plan, among other factors. Prescription drug plans vary, as will the list of drugs (formulary) covered by the plan.
Does Medicaid cover Trelegy Ellipta?
Medicaid usually covers Trelegy Ellipta, but coverage ultimately depends on your plan and state of residence. Even though prescription drug coverage is optional under federal Medicaid law, all states currently provide some form of coverage for outpatient drugs like Trelegy Ellipta.
According to GSK, the manufacturer of Trelegy Ellipta, most Medicaid beneficiaries pay $4–$9 per month for their medication. The best way to find out whether your state’s Medicaid plan covers Trelegy and learn how much it will cost you out of pocket is to contact your state’s Medicaid agency.
Factors influencing Medicaid coverage for Trelegy Ellipta
The price you pay for Trelegy Ellipta with Medicaid, your drug copay, depends on the details of your specific state plan.
For example, Medicaid programs may use drug utilization management techniques. An example of one such technique is the act of encouraging states to omit high-cost drugs from their prescription drug formularies. Or, they may approve them if lower-cost alternatives are ineffective. This is also called step therapy.
Another example of a drug utilization management technique is requiring prior authorization before covering the drug. Prior authorization is a standard process among health insurance companies, including Medicaid. It essentially involves ensuring that prescribed treatments are medically necessary. If your state Medicaid program requires prior authorization for Trelegy Ellipta, it will coordinate coverage with your healthcare provider, who will be asked to prove that your treatment is medically necessary. This process may take time, so be sure to allow 2–10 business days, or even more in some cases, for Medicaid to approve coverage of Trelegy Ellipta.
How to get discounts on Trelegy without Medicaid
There are ways to save on Trelegy Ellipta if you don’t have Medicaid or if it isn’t on your Medicaid plan’s preferred drug list, which is also called a formulary. For example, with a SingleCare prescription discount card, you can access online coupons you can show to your pharmacist at participating pharmacies around the country to save hundreds of dollars on your prescription, as well as refills. With a SingleCare coupon, you could pay as low as $504 instead of $879 per Trelegy Ellipta inhaler. This saves you $375 per month—and $4,500 per year.
If you find that you simply cannot afford Trelegy, or if it isn’t on your Medicaid plan’s preferred drug list, talk with your healthcare provider about Trelegy alternatives. They may be able to prescribe an alternative, such as Advair Diskus, Symbicort, Breo Ellipta, Dulera, or Anoro Ellipta, to help you manage your COPD or asthma symptoms instead of Trelegy. Dr. O’Mahoney recommends always letting your healthcare provider know if the medication they prescribe you is too expensive. “You want to see if there is a more affordable solution rather than stopping the medication and going without.”
RELATED: Does Medicare cover Trelegy Ellipta?
Sources
- Bronchodilators, StatPearls (2023)
- GSK pricing information, GSK (2024)
- Where can people get help with Medicaid & CHIP?, Centers for Medicare & Medicaid Services
- Medicaid’s prescription drug benefit: Key facts, KFF (2019)