Is Fasenra covered by Medicare?

In this article:

• How much does Fasenra cost?
• Does Medicare cover Fasenra?
• Cost of Fasenra with Medicare
• How to save on Fasenra

In this article

• How much does Fasenra cost?
• Does Medicare cover Fasenra?
• Cost of Fasenra with Medicare
• How to save on Fasenra

The ability to breathe easily is something people may take for granted, but not people with severe eosinophilic asthma—when a certain type of white blood cells called eosinophils cause inflammation in the airways, impeding lung function. Often prescribed alongside systemic corticosteroids, Fasenra (benralizumab) is an injectable biologic medication that targets and eliminates those white blood cells. But like many biologics, its initial prices can seem daunting.

The exact amount you pay for Fasenra depends on factors such as where you purchase it and what your insurance covers. Medicare will often cover at least part of Fasenra’s costs under Part B or Part D, but it depends on the plan and where the drug is administered—in a healthcare provider’s office or at home.

How much does Fasenra cost?

Insurance can significantly reduce Fasenra’s out-of-pocket expenses, but for people paying entirely out of pocket, it can cost about $7,715 for one 30 mg/mL injection. “It is injected under the skin once per month for three months, and then once every two months after that,” says Tanya Feke, MD, a health policy analyst. That means a year of treatment could cost almost $50,000 without insurance or Medicare. 

Not everyone pays that price. Aside from Medicare, Medicaid, and insurance coverage, there are a few other factors that can influence it. For example, prices can vary between pharmacies since each pharmacy sets its own prices based on how much they pay for the drug, their overhead costs, and other circumstances.

Biologic drugs like Fasenra often cost more than other drugs because of their unique development and complex structure. Unlike many medicines, which are chemically synthesized, biologics are created from living cells—a costly and time-consuming process. Some biologics have biosimilars, which are more affordable alternatives to brand-name biologics and can cost much less. Unfortunately, Fasenra doesn’t yet have a direct biosimilar substitute, and “with a patent that will not expire until 2033, the cost is unlikely to decrease anytime soon,” Dr. Feke says.

Does Medicare cover Fasenra?

Yes, many Medicare plans may cover part of Fasenra treatment. How much they will cover varies based on the specific insurance provider and policy. Which part of Medicare provides this coverage depends on whether a healthcare professional administers the injection in their office or the patient administers it at home.

However, some drug plans may require the prescribing healthcare provider to verify Fasenra’s medical necessity first, according to Ojas Doshi, a product development scientist in the pharmaceutical industry. “This primarily means that the patient has been diagnosed with severe eosinophilic asthma, which has responded insufficiently to conventional therapies.” This process is called prior authorization. If a particular plan requires it, “the healthcare provider will need to submit medical records for the patient that include the patient’s diagnosis, description of previous treatments, and why Fasenra is being recommended,” Doshi says. Some plans may also require patients to try other medications first, a restriction known as step therapy.

Is Fasenra covered by Medicare Part B?

“Fasenra is one of the few medications that can be covered by either Medicare Part B or Medicare Part D. You will need to reach out to your healthcare provider to see if they offer it under Part B,” says Dr. Feke.

Medicare Part B handles outpatient medical services, office visits, home health care, and more. That’s why “Medicare Part B generally covers biologic treatments like Fasenra when administered in a healthcare setting, such as a doctor’s office or hospital,” says Sazan Sylejmani, Pharm.D. “This is because these medications are typically considered durable medical equipment (DME) by Medicare.” Medicare data shows that, in 2022, Part B plans covered nearly $217 million of Fasenra on over 45,000 claims.

Is Fasenra covered by Medicare Part D?

“When Fasenra is approved for administration by the patient at home (which is not the norm), it becomes a Part D benefit,” Doshi says. “The patient would pick up the medication at a pharmacy.” In these cases, the healthcare provider typically provides training or instructions for use. Since Part D comprises standalone outpatient drug plans beneficiaries can add to their Medicare Part A and Part B policies, some people might have both Part B and Part D. Part D plans covered around $119 million worth of Fasenra pens (the at-home injector) in 2022, as well as over $65 million in regular Fasenra.

Cost of Fasenra with Medicare

Once again, what you pay depends on which part of Medicare covers your treatment. People who have coverage under Medicare Part B and no supplemental plan will have to pay a 20% coinsurance for Fasenra. Assuming the $7,715 price from above, that 20% comes out to around $1,543. But remember, the price before insurance can vary significantly.

According to AstraZeneca, the manufacturer of Fasenra, patients with Medicare Advantage plans (Part C)—which often include Part D—pay an average of $90 per dose. But that depends entirely on the specific plan. 

How to save on Fasenra

There are ways to save on Fasenra, although not all are available to Medicare beneficiaries. Here are a few you can consider if your Medicare plan won’t cover Fasenra or if your out-of-pocket costs with Medicare are too high.

1. Sign up for a free SingleCare prescription discount card. By working directly with over 35,000 pharmacies, SingleCare has secured discounts on thousands of medications. Everyone is eligible for a SingleCare card, even if they have Medicare. Just know that you can’t use these discounts on top of Medicare coverage. 

Your healthcare provider may have Fasenra in their office, or they may have to order it from a specialty pharmacy, which will deliver it either to your healthcare provider or to your home (if you’re self-administering the Fasenra pen). At the time of publication, a SingleCare card could reduce the cost from $7,715 to $5,517 per syringe. 

2. Apply for Fasenra patient assistance. AstraZeneca has a program called AZ&Me that’s specifically for uninsured individuals and people who have Medicare but still need help paying for their medications. If you don’t have private insurance and you have an annual adjusted gross income at or below 300% of the federal poverty level, you could get Fasenra for free. The savings program lasts for 12 months, and you can re-enroll after that.
3. Look into Medicare Extra Help. A Medicare program called Extra Help can help eligible beneficiaries pay for Fasenra if it is being covered under Part D or the prescription portion of Medicare Advantage. If eligible, you could pay $0 for your Medicare premiums, have no deductible, and pay just $12.15 for brand-name prescriptions like Fasenra. Anyone who gets accepted for Medicaid is automatically enrolled in Extra Help. 

4. Look into a Medicare Savings Program. A Medicare Savings Program administered by your state may help offset certain Part B costs. In some instances, this may include premiums, deductibles, or coinsurance. Contact your local state Medicaid office for details and to apply.