Does Medicare cover Trelegy Ellipta?

In this article:

• Does Medicare cover Trelegy? 
• Factors influencing Medicare coverage of Trelegy 
• How much does Trelegy cost?

In this article

• Does Medicare cover Trelegy? 
• Factors influencing Medicare coverage of Trelegy 
• How much does Trelegy cost?

For nearly 4.6% of adults in the United States, the coughing, wheezing, and difficulty breathing of chronic obstructive pulmonary disease (COPD) is a daily battle. Fortunately, drugs like Trelegy Ellipta can help. Trelegy is a combination inhaler that contains three ingredients to prevent and control the symptoms of chronic bronchitis, emphysema, and even asthma. It is not a rescue inhaler for acute symptoms like shortness of breath and wheezing. Its price can vary based on insurance coverage and your purpose for taking it, but some Medicare Part D plans may help pay. 

Does Medicare cover Trelegy? 

“Many Medicare Part D plans cover Trelegy Ellipta,” says Tanya Feke, MD, health policy analyst for medicareresources.org. “In fact, more than 834,000 Medicare beneficiaries used Trelegy in 2022, costing Medicare Part D $3.34 billion. This was the eighth most expensive drug expenditure for the program that year. To show how popular the drug has become, Medicare Part D covered half as many beneficiaries, approximately 419,000, in 2020 at a cost of $1.48 billion.”

Medicare Part A and Part B plans don’t automatically come with prescription drug coverage. That’s why beneficiaries can add on standalone Part D plans, which help cover drug costs. Medicare Advantage (Part C) plans—which include Parts A and B and are offered by private companies that contract with Medicare—usually come pre-bundled with Part D plans, but not always. Plus, not every Medicare prescription drug plan covers Trelegy. To know for sure, check your health plan’s formulary (drug list).

Factors influencing Medicare coverage of Trelegy 

Until the Inflation Reduction Act of 2022, Medicare couldn’t negotiate with pharmaceutical companies for lower prices, according to Dr. Feke. “That all changes in 2026. Given its increasing expenditures for Medicare, it is not surprising that Trelegy is one of the drugs expected to undergo price negotiations,” she says.

However, “not all plans may cover the drug outright. Because Part D plans want to decrease their spending too, they may require prior authorizations or step therapy before they approve the drug for coverage. This can make it more difficult to access the drug.” Step therapy is when the plan requires patients to try other, often less expensive, drugs before moving up to a more expensive one.

How much does Trelegy cost?

Medicare and insurance are reliable ways to reduce the cost of Trelegy, but some people don’t have access. Without outside assistance from insurance, discounts, or other sources, Trelegy costs an average of $872 per 30-day supply.

Yet that’s just an average, not a set price. Each pharmacy sets its own prices for drugs, so different locations have different prices, even in the same town. “It depends on other expenses like employee salaries, benefits, and other expenditures like rent, utilities, and more,” says Ben Gibson, Pharm.D., a pharmacist, speaker, and medical writer. “Pharmacies have third-party supplies who deliver medication, and they have their own set of expenses.”

Regardless of the starting price, discount cards, patient assistance programs, and other financial support can knock down the price of Trelegy at checkout.

Cost of Trelegy inhaler with Medicare

Even people who have Medicare coverage might see fluctuation in Trelegy prices. The drug’s manufacturer, GSK, says that since the cycle of coverage changes throughout the calendar year, Medicare beneficiaries may go through anywhere from one to four phases of coverage—each with a different out-of-pocket cost. Ultimately, the price you pay for your prescription may change throughout the year.

Most Medicare and insurance plans have cost-sharing policies, where the beneficiaries are responsible for copays, coinsurance, and more. The specific out-of-pocket costs vary between plans, but the patient often has to pay something—even if it’s small.

GSK claims that 78.4% of people with Medicare prescription drug coverage for Trelegy pay less than $50 per month, and the remaining 21.6% pay around $182 per month.

Beneficiaries who qualify for Medicare Extra Help may be able to get Trelegy Ellipta for $12.15 or less, with no deductible or plan premiums. 

Savings options if Medicare doesn’t cover Trelegy

If your insurance company or Medicare prescription plan doesn’t cover Trelegy, there are still several effective ways to cut costs. Here are a few of the most reliable. 

Enroll in the GSK patient assistance program

Drug manufacturers are well aware of the prices their prescription medications command, and some have made efforts to help patients afford them, including GSK. With GSK for You, anyone based in the United States who has Medicare or no insurance at all—and meets other financial requirements—might get Trelegy at no cost. To qualify, patients must not be co-enrolled in any assistance programs from the government, nonprofits, or other third parties.

Eligible patients can enroll by mail, fax, or phone, and if accepted, they must re-enroll every 12 months. 

RELATED: Trelegy Ellipta patient assistance program: Eligibility & more

Sign up for the Trelegy savings program

As we mentioned, insurance coverage doesn’t necessarily mean free or low-cost Trelegy. Some plans will only cover a small portion of the drug’s total cost. For these people, Trelegy has a savings program that may cover the rest.

Uninsured patients are eligible for this program, as are patients with private health insurance plans that cover some (but not all) of their Trelegy price. Either way, the eligibility requirements say enrollees must not receive assistance from Medicare, Medicaid, or other government programs. The maximum this card covers for insured patients in 2024 is $500 per month between Jan. 1 and March 31, and $200 per month for the rest of the year. Uninsured patients may save up to $100 per month. This offer expires on Dec. 31, 2024, but you can check the website periodically to see if new savings are added.

Use other Trelegy coupons

SingleCare has coupons for thousands of drugs, including Trelegy, and they’re redeemable at over 35,000 pharmacies nationwide. By signing up for a free SingleCare card, you could get Trelegy for around $525 instead of the $872 average. You can’t use SingleCare’s Trelegy coupons simultaneously with insurance or Medicare coverage, but they’re a good option for people whose plans don’t cover Trelegy.

Consider two-inhaler treatment

Each Trelegy inhaler contains three different drugs: fluticasone furoate, umeclidinium, and vilanterol. Administering all three at once is convenient, but some people use two separate inhalers instead, which may come at a lower cost. There are a couple of studies that demonstrated that three-in-one treatment is slightly more effective and affordable, but that’s not the case for everyone.

“This is not a starter medicine. People using a medication with this many active ingredients tend to have more serious lung disease. Your healthcare provider should evaluate your condition and make sure that you require this level of medication,” Dr. Feke says. “If so, and if you have reasonable drug coverage, it may be worth it to go for Trelegy. If not, using two or more medications to cover the recommended drugs may be a good option.” So, ask your healthcare provider for additional information on whether two-inhaler treatment—or Trelegy alternatives—might be a viable option.

Locate cheaper pharmacy options

Pharmacies are like any other store—they determine their own prices. And those prices can vary quite a bit. Calling around to several different pharmacies could help you find the best price on Trelegy in your area.